Case report: cerebral myiasis

Introduction: Cerebral myiasis is an extremely rare condition caused by the infestation of dipteran larvae, which feed on the living or necrotic tissue of the host. Only 18 cases of cerebral myiasis have been reported so far, the first being described by Froomin and Kaznelson et al., in 1939. Objectives: To summarize the clinical evolution of a patient with severe myiasis that evolved with osteolytic lesion of the cranial calvaria and subsequent involvement of the nervous parenchyma, associated with secondary infection. Methods: Description of the clinical condition and the surgical procedure based on the review of the patient's chart. Prior approval of the current report by the Research Ethics Committee, of the University Center Padre Albino (UNIFIPA) - CAAE: 68395723.7.0000.5430. Results: A 78-year-old patient presented with larval infestation under a previous injury, in the scalp region, associated with purulent discharge. Admitted to hospital care with lack of appetite, vomiting and slight lowering of the level of consciousness. Initial procedure for mechanical removal of larvae was performed, vermifuge and antibiotic therapy were administered. A computed tomography scan showed the formation of pneumocephalus and involvement of the brain parenchyma. During the patient's hospitalization, it was necessary to perform a new procedure due to the formation of an abscess in an infected site and replacement of antimicrobial therapy. The patient died in a palliative care ward due to impaired general functionality. Conclusion: Elderly patients with profound involvement of the brain parenchyma due to myiasis, associated with secondary infection, are more likely to have an unfavorable outcome. The identification of the larval species and, consequently, its life cycle contributes to several clinical aspects, such as calculating the time of infestation, establishing the therapeutic approach and promoting preventive measures.