Cranial Osteomyelitis Secondary to Myiasis: Case Report

Abstract A 48-year-old male patient was admitted to an emergency care unit with a history of gunshot wound and traumatic brain injury. He underwent neurosurgical debridement, with removal of fractured bone fragments in the left frontal region, drainage of the underlying brain contusion, and dural plastic surgery. He showed clinical improvement, underwent autologous cranioplasty approximately 4 weeks after the hospital admission, and was discharged for neurological outpatient follow-up. After 6 months, he returned to the hospital with signs of dehiscence of the surgical wound in the left frontal region, with the presence of larvae at the site, compatible with the diagnosis of cranial myiasis. He underwent two debridements of the surgical site to remove visible larvae on the bone flap, which also showed signs of infectious involvement, confirming the diagnosis of osteomyelitis. A wide left frontal craniectomy was also performed, with removal of the infected cranial bone. The culture of surgical material showed the presence of the bacterium Klebsiella aerogenes. Ivermectin and broad-spectrum antibiotic therapy were prescribed. The patient showed good progress and was discharged from the hospital. Myiasis is caused by the fly Dermatobia hominis, whose eggs are laid in open wounds, where their larvae feed on tissues and body fluids. It is usually a self-limiting condition with low morbidity, except in the presence of cranial osteomyelitis, a rare complication that can lead to amaurosis, sepsis, and death. Therefore, rigorous removal of the larvae, extensive surgical debridement, craniectomy, and prolonged antibiotic therapy are the main therapeutic strategies.