[SavageGlow]

A 70-year-old male presented to the ER department with a chief complaint of intense pain in his left elbow for three days and a skin wound that was not healing. The patient attempted to clean and debride the wound but noticed that purulent drainage was still present afterward. On physical examination, the patient appeared well-developed but unkempt. He was alert and oriented to person, place, and time. The physical exam was remarkable only for a left arm (elbow) abscess. The patient's medical history was significant for hypertension, previous bilateral kidney surgery, and decreased sensitivity of the upper extremities due to healed severe burn lesions. On inspection, the affected area showed a sizeable erythematous wound with well-demarcated borders. The lesion was swollen and warm to the touch, with necrotic tissue and drainage. No areas of abrasions, lacerations, or ecchymosis were noted.

On the first attempt to uncover the wound, hundreds of live maggots were easily seen with moderate amounts of foul-smelling purulent discharge. In a further interview with the patient, he communicated that he believed an insect bite might have caused the wound. He likes to work in his garden and does not use skin protection while doing so. He denied any fever, swelling, vomiting, recent trauma, or IV drug usage.

The patient was started on vancomycin, piperacillin/tazobactam, and ivermectin, and the orthopedic department was consulted for possible left elbow bursitis or septic arthritis. A left elbow XR was ordered and showed a soft tissue defect of the left elbow with soft tissue swelling, which may represent an ulcer, and thickening of the supracondylar humeral cortex, which may represent a previously healed fracture.

The plastic surgery department was consulted for further management of the lesion. The team successfully removed the necrotic tissue and all visible larvae at the bedside with the help of a pulse irrigator. A tissue biopsy with larvae was taken and sent to the lab for proper identification. The patient was transferred to the internal medicine team and the wound care team.

[mr_feelgood]

Got a whole ecosystem in his elbow

[kellyhound]

Originally Posted by SavageGlow ↗

A tissue biopsy with larvae was taken and sent to the lab for proper identification.

Turned out to be
https://en.wikipedia.org/wiki/Flesh_fly

This was a Hispanic male and a case from last year February in Florida. Also poor hygiene and homelessness, likely contributed to the infestation.

The Sarcophagidae family was initially found in temperate climates like the Arabian Peninsula and Japan, but nowadays, they inhabit a vast geographic distribution that includes Southern Florida and Central and South America.

The flesh-fly females are viviparous organisms. The eggs hatch inside the fly’s abdomen and are then deposited as larvae in the specific tissue. This mechanism gives the flesh fly larvae a significant advantage compared to their competitors when it comes to food and resource scavenging. The larvae can start feeding on tissue readily rather than waiting to hatch from the egg.

A delay in treatment allows the larvae to grow unrestricted, as each female can produce over a 100 eggs, and each is capable of producing more than 25 larvae at one time.

[SavageGlow]

Originally Posted by kellyhound ↗

Turned out to be
https://en.wikipedia.org/wiki/Flesh_fly

This was a Hispanic male and a case from last year February in Florida. Also poor hygiene and homelessness, likely contributed to the infestation.

The Sarcophagidae family was initially found in temperate climates like the Arabian Peninsula and Japan, but nowadays, they inhabit a vast geographic distribution that includes Southern Florida and Central and South America.

The flesh-fly females are viviparous organisms. The eggs hatch inside the fly’s abdomen and are then deposited as larvae in the specific tissue. This mechanism gives the flesh fly larvae a significant advantage compared to their competitors when it comes to food and resource scavenging. The larvae can start feeding on tissue readily rather than waiting to hatch from the egg.

A delay in treatment allows the larvae to grow unrestricted, as each female can produce over a 100 eggs, and each is capable of producing more than 25 larvae at one time.

[Elizabeth76]

My worst fear!

[ajs11961]

How do you not realize there are things squirming under your skin?????

[Boneshaker]

So, he ''noticed' there was a little drainage on his elbow. ok then..