Scalp myiasis presenting as forehead edema in a returning traveller from Belize

Abstract Objective : We present a case of furuncular myiasis in a returning traveller from Belize, characteristically presented with forehead/eyelid edema and two crusted papules on the scalp, atypical symptoms that led to an incorrect initial diagnosis of rickettsial infection. Clinical case : A 60-year-old Venezuelan woman with no previous medical history presented with a 4-day history of the forehead and left eyelid edema and two subcentrimetric crusted lesions on the scalp frontoparietal area after tourism travel to Belize in the preceding month. She presented to a dermatological clinic 10 days after her arrival and a diagnosis of rickettsial infection was suspected based on clinical and epidemiological information, prescribing treatment with oral corticosteroids and doxycycline. After posterior evaluation in our outpatient clinic vaseline occlusion was carried out due to suspicion of scalp myiasis and antibiotic was suspended. Both larvae could be removed and the patient showed complete resolution of symptoms and recovery from the skin infestation. Conclusion : The diagnosis of scalp myiasis in the context of atypical symptoms is challenging. Health professionals should be aware of this possible aetiology in facial/forehead edema in returning travellers from endemic regions.