This is the case of a 91-year-old female patient who presented with a relative in the emergency department of a referral hospital in San José, Costa Rica.
The reason for consultation was an abdominal pain radiating to the left anterior superior iliac crest, which worsened with changes in position.
The most important antecedents were longstanding arterial hypertension and persistent cough of one month duration.
At the time of the physical examination, the patient presented mobility of the four limbs, nausea, mildly dry mucosa, mild to moderate dry mouth, and malnutrition.
In the abdominal region, it was noticed a blushing abdomen and tenderness to palpation in the absence of masses.
The patient was hemodynamically stable and the Orthodontic Service ruled out fractures.
Pupils were classified as hyporeactive and chest X-ray revealed severe pulmonary involvement with bilateral infiltrates.
Due to his condition, he was admitted to the hospital where he began with the studies of radiology and blood chemistry.
Laboratory results showed electrolyte imbalance, acidemia and frank leukocytosis with the presence of bands, which was associated with a possible sepsis.
Due to pulmonary involvement, mechanical ventilation and nutrition support was established through a nasogastric tube.
From that moment on, the patient's health was at a progressive expense.
On the seventh day after admission, the nursing staff reported the presence of larvae from both nostrils.
During the next 24 hours, five of these larvae were collected for the determination of the species and treatment was initiated with reverse transcriptase.
According to medical records, in the following days no larvae were visualized; however, the patient died due to acute bronchopneumonia aggravated by acute renal failure on the twelfth day of hospitalization.
Three larvae collected were fixed in 70% alcohol and referred to the Medical Entomology Laboratory of the Faculty of Microbiology, University of Costa Rica, for species determination.
The material was dissected and cleared in lactophenol for 24 hours, was placed between blade and laminilla and subsequently photographed using Hoyer's medium.
1.
Microscopic observation of third stage larvae allowed establishing the following characteristics: less cephalometric cystoid cystoid openings with cuticular spines uniccuspids grouped into two to seven external propharyngeal rows; no less access;
According to the dichotomic key of Thyssen (6), the criteria described by Pirali-Kheirabadi, et al. (7), and Nazni, et al. (8), and the morphologic analysis of the larvae
On the same day as the larvae were evidenced, five adult flies were collected using entomological nets outside the hospital, with a roof at the lounge where the patient was hospitalized.
The identification of these flies corresponded to L. cuprina and Musca domestica (9).
