This 62-ear-ld woman was evaluated for 2 painful nodules on her left arm and left posterior shoulder 2 months after attending her daughter's wedding in Argentina. During her visit abroad she went hiking and sustained multiple mosquito bites. All of these bites healed except for the 2 which were seen at the time of her visit. She complained of 2 weeks of sharp, dart-like sensations about 6 times a day associated with the discharge of a brownish liquid from small openings in the nodules. Close inspection of the nodules revealed intermittent emergence of larvae heads from a small punctum overlying each nodule. Excision under local anethesia confirmed the presence of two botfly larvae, each measuring approximately 1.5 to 2 cm. The wounds healed without complications.
red tender nodule with central opening and surrounding erythema