Cerebral myiasis associated with angiosarcoma of the scalp: case report.
OBJECTIVE
Primary human cerebral myiasis is an exceedingly rare condition and is almost never encountered by physicians in developed countries. The case report summarizes a case of extensive cerebral myiasis in a periurban community in the United States.


METHODS
After a minor motor vehicle accident, police brought a 75-year-old man to the emergency room because he was observed to have a large cranial lesion. Examination revealed a 15 x 17 cm frontal bone defect with eroded frontal dura, exposed cortex, and massive cortical maggot infestation.


METHODS
The patient was empirically treated with intravenous antibiotics for meningitis. Maggots (Phaenicia sericata, or the green bottle fly) were removed by suction, attrition, and gentle contact exposure to a mild bleach solution. Biopsy of the scalp and cranium revealed angiosarcoma, for which operative treatment was refused. The patient was transferred to a skilled nursing facility for palliative care where he died 3 months later.


CONCLUSIONS
This is the first published case of cerebral myiasis in the United States. Although human cerebral myiasis is rare, conditions do exist in this country that permit myiasis.
Cheshier
Samuel H
SH
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California 94305, USA. sam@samuelcheshier.com
Bababeygy
Simon R
SR
Higgins
Dominique
D
Parsonnet
Julie
J
Huhn
Stephen L
SL
D000368:Aged; D001927:Brain Diseases / Q000175:diagnosis / Q000469:parasitology* / Q000628:therapy*; D006801:Humans; D008297:Male; D009198:Myiasis / Q000175:diagnosis* / Q000469:parasitology* / Q000628:therapy*; D012535:Scalp / Q000469:parasitology*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000469:parasitology*