Journal of Clinical and Investigative Dermatology

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Case Series

Cutaneous Furuncular Myiasis: A Case Series from Yemen

Alshami MA1*, Alshami AM2, Alshami HM1 and Lutf RM1

1Department of Dermatology, Faculty of Medicine and Medical Sciences, Sana’a University, Sana’a, Yemen
2Department of Conservative Dentistry, Faculty of Dentistry, Sana’a University, Sana’a, Yemen
*Address for Correspondence:Mohammad Ali Alshami, Department of Dermatology, Faculty of Medicine and Medical Sciences, Sana’a University, Sana’a 1064, Yemen. E-mail Id: mohammadalshami62@gmail.com
Submission: 26 July, 2026 Accepted: 24 August, 2026 Published: 28 August, 2026
Copyright: © 2026 Alshami MA, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Myiasis is defined as the infestation of living humans or animals by the larvae of two-winged flies (order Diptera). The affected sites may be cutaneous or extracutaneous, with cutaneous myiasis further classified into furuncular, migratory, and wound forms. Herein, we present four cases of cutaneous furuncular myiasis that, to the best of our knowledge, represent the first reported cases of this condition in Yemen. None of the patients had any history of travel outside Yemen, making this case series particularly noteworthy. Following clinical evaluation, an entomologist at our university identified the larvae as third-instar larvae of Dermatobia hominis in one patient and thirdinstar larvae of Cordylobia anthropophaga in the remaining three patients. This case series aims to increase awareness among medical personnel and to advise individuals at risk of C. anthropophaga infestation to iron linen and clothing after washing, avoid drying laundry outside, particularly near the ground and in the shade, and avoid wearing clothes that have been placed on the ground in the shade. Additionally, this case series provides evidence that these flies, despite being native to tropical areas, may be found outside of these regions owing to international travel, through which eggs or larvae are inadvertently transported.

Introduction

Myiasis is the infestation of living humans or other vertebrate animals by the larvae of two-winged flies (order Diptera), which feed, for at least part of their development, on the living or dead tissues of the host.[1] Myiasis is classified as cutaneous or extracutaneous, with cutaneous myiasis further subdivided into the furuncular, migratory, and wound forms. Among these clinical forms, the furuncular form is the most common.[2] Although myiasis is endemic in tropical regions of the Americas and Africa, cases have been reported worldwide.[2] Nevertheless, a MEDLINE search using the search terms “furuncular
Table 1.Summary of clinical findings, causative larvae, and treatment of the presented cases.
myiasis” and “Yemen” did not identify any previously published reports of furuncular cutaneous myiasis from Yemen. Therefore, we report a case series of four patients with this condition.

Case reports

Figure 1a:An erythematous nodule on the ulnar aspect of the right hand, covered with white petrolatum. This patient had a single painful lesion on an exposed area, consistent with furuncular myiasis caused by Dermatobia hominis.c
Figure 1b:A close-up view of the central punctum of the nodule, showing the posterior end of the larva visible through the skin.
Figure 1c:The D. hominis larva protruding through the skin at its posterior end. Note the black body spicules.
Figure 1d: The D. hominis larva showing characteristic black spicules, which are absent from the three terminal segments; posterior respiratory spiracles located away from the skin surface; and mouthparts at the anterior end in close contact with the skin.
(Table 1) presents a summary of the clinical findings of the four presented cases.

Case 1

An 18-year-old woman presented with a 3-week history of swelling on the ulnar aspect of her right hand that had become painful over the preceding 2 weeks. The patient recalled experiencing an insect bite at the same site at the onset of symptoms. Cutaneous examination revealed an erythematous nodule. The posterior end of the larva, bearing the posterior spiracles, was visible through the central pore of the nodule. After the area was covered with white petrolatum, the patient observed slight movement and protrusion of an object from the center of the lesion. A larva was subsequently removed by applying gentle pressure. The larva exhibited black circular spicules on the proximal body segments and two black tubercles at the distal end. Based on its typical morphology, a third-instar larva of the fly Dermatobia hominis was suspected and subsequently confirmed by an entomologist at the Department of Agriculture, Sana’a University (Figure 1a–1d). Based on the clinical findings (a single lesion on an exposed area) and the larval morphology, a diagnosis of furuncular cutaneous myiasis caused by D. hominis was established. The patient was prescribed topical mupirocin ointment and oral azithromycin (500 mg), and the lesion showed visible improvement after 1 week.
Case 2:
A 2-year-old boy presented with a 3-week history of multiple tender nodules on the trunk. The posterior end of the larva, bearing the posterior spiracles, was visible through the central punctum of the nodules. A single larva was manually extracted by applying gentle pressure to the sides of a lesion on the right side of the abdomen and was subsequently identified by an entomologist as a third-instar larva of Cordylobia anthropophaga based on its morphological features. Because the affected areas were normally covered by clothing, transmission was speculated to have occurred through contact with damp clothing or via a mechanical carrier, such as a mosquito (Figure 2a–2f). Topical mupirocin ointment and oral azithromycin suspension (250 mg) were administered, achieving complete healing after 1 week.
Case 3:
An 8-year-old boy presented with a 2-week history of two
Figure 2a:Multiple nodules on the left side of the upper trunk.
Figure 2b:A close-up view of the lower nodule shown in Figure 2a, with the larva visible through the skin.
Figure 2c:Three scattered nodules on the right lower back. The involvement of covered areas and the presence of multiple lesions were consistent with myiasis caused by Cordylobia anthropophaga.
Figure 2d:A lesion on the right lower abdomen before larval extraction.
Figure 2e: C.anthropophaga larva on the skin of the right lower abdomen
Figure 2f:The lesion shown in Figure 2d after larval removal, with mupirocin ointment applied.
nodules on the medial aspect of his left thigh. The posterior end of the larva, bearing the posterior spiracles, was visible through the central punctum of the nodule. Based on the morphological features of several larval specimens provided by the patient and a larva extracted in the clinic, the larvae were identified by an entomologist as third- instar larvae of C. anthropophaga. As in Case 2, the affected areas were normally covered by clothing (Figure 3a–3c). Treatment with topical fusidic acid (Fucidin) ointment and oral azithromycin (250 mg) resulted in complete healing after 10 days.
Case 4:
A 3-year-old girl presented with a 2-week history of multiple tender nodules on her arms, from which larvae had been manually extracted by her father, who also provided videos documenting the extraction process (Videos 1–3). The posterior end of the larva, bearing the posterior spiracles, was visible through the central punctum of the nodule. The affected body regions were normally covered by clothing. The presence of multiple lesions was suggestive of C. anthropophaga as the causative species. Treatment with topical mupirocin ointment and oral azithromycin (250 mg) resulted in complete healing after 7 days.

Discussion

Figure 3a:The medial aspect of the left upper thigh. The larva emerged spontaneously after application of fusidic acid (Fucidin) ointment to the punctum.
Figure 3b:The extracted C. anthropophaga larva.
Figure 3c:Larvae self-extracted by the patient and provided to the investigators.
Table 2Reported Cases of Furuncular Myiasis in Arabian Countries.
Reporting four cases of furuncular myiasis is very unusual in an area distant from the natural habitat of myiasis-causing flies, namely tropical Africa and Central America; however, this unusual finding may be explained by the possible transport of their eggs or the flies themselves via transport vehicles such as airplanes, ships, or trains. Conversely, numerous cases have been reported from countries distant from the endemic areas of these flies, including Europe, North America, and Asia. Approximately 12 cases of furuncular myiasis have been reported in Saudi Arabia, the northern neighbor of Yemen (Table 2).
In contrast to D. hominis, C. anthropophaga typically penetrates the skin less deeply, although mild pruritus may occur for up to 2 days after infestation. The lesion initially appears as a reddish papule that develops into a boil-like nodule with a central pustule. Erythema may develop in the surrounding tissue within a few days.[7] The mature third-instar larva typically leaves the host after 1–2 weeks, and the posterior spiracles may sometimes be visible through the central pore. Multiple lesions may be associated with systemic symptoms, such as regional lymphadenopathy or malaise.
Infestations with C. anthropophaga most commonly occur during the rainy season. Adult flies oviposit on soiled clothing, which explains the distribution of lesions on covered body sites, such as the trunk, buttocks, and thighs, as well as the greater number of lesions observed in affected individuals. [7] Additionally, the thinner skin and immature immune system of infants may explain their increased susceptibility to infestation. In the presented cases the actual route of infection was unfortunately not established.
In its furuncular form, cutaneous myiasis manifests as boil-like lesions on exposed areas of the skin, such as the face, arms, scalp, or legs, which gradually develop over the course of a few days. A characteristic feature of these lesions is the central punctum, which facilitates air exchange within the lesion and through which the larvae discharge serosanguineous fluid. These puncta can be readily identified with the aid of a magnifying glass or by observing air bubbles that rise when the affected area is submerged in water. The posterior end of the larva, bearing the posterior spiracles, is generally visible through the punctum, as observed in all four cases described above. However, these furuncular lesions resolve rapidly after the larva emerges or is removed.
A definitive diagnosis of myiasis is generally established by extracting and identifying the infesting larva based on its characteristic morphology. However, in clinical practice, the diagnosis is typically based on characteristic clinical findings (the site and number of lesions), particularly in endemic areas. The injection of lidocaine around the lesion may facilitate painless larval extraction. Treatment consists of occlusion therapy, manual extraction of the larva, and topical or oral ivermectin. Topical and, occasionally, systemic antibiotics are used to prevent secondary bacterial infection and to facilitate healing, which was the case in the presented cases [2]. This case series emphasizes the importance of considering furuncular myiasis in lesions resembling boils, particularly in children living in resource-limited settings.
Video 1. Case 4. Manual extraction of the larva by the patient’s father.
Video 2. Case 4. Larva after extraction from the skin.
Video 3. Case 4. Multiple larvae after extraction from the skin.

Citation

Alshami MA, Alshami AM, Alshami HM, Lutf RM. Cutaneous Furuncular Myiasis: A Case Series from Yemen. J Clin Investigat Dermatol. 2026;14(1): 1