Unmasking Nasal Myiasis in a Rural Ethiopian Patient with Recurrent Epistaxis: A Case Report

Nasal myiasis is an uncommon parasitic infestation of the nostril caused by fly larvae, often occurring in individuals from rural areas with poor hygiene or chronic nasal disease. It may rarely present with active nasal bleeding (epistaxis), which can mimic other common nasal pathologies. A 65-year-old female from a rural area presented with continuous right-sided nasal bleeding of four days’ duration, associated with nasal itching, obstruction, and foul-smelling discharge. She reported similar episodes over the past year but had not sought medical attention. Her medical history was significant for unspecified heart disease, for which she was taking enalapril 5 mg and furosemide 40 mg orally once daily each. On arrival to the emergency department, she was hemodynamically stable except for tachycardia (pulse rate 118 bpm). Local examination revealed active right-sided epistaxis. Digital compression and topical epinephrine-soaked gauze reduced the bleeding, after which multiple live larvae were visualized and removed manually under direct vision. The nostril was irrigated with normal saline, and the patient was started on intravenous ceftriaxone 1 gm twice daily and a single oral dose of ivermectin 200 µg/kg. The patient showed marked improvement, and the bleeding ceased completely. This case highlights nasal myiasis as a rare but important cause of persistent epistaxis, particularly in rural or low-resource settings. Early identification and prompt removal of larvae, combined with systemic antibiotics and ivermectin, are crucial for achieving favorable outcomes and preventing complications.