Rat-tailed maggot urinary myiasis

A 32-year-old woman from South Brazil presented to the emergency department after passing a 1.5-cm living organism during micturition, which was collected and brought for analysis (Figure 1, Supplementary Video 1). She had developed intense dysuria and suprapubic tenderness a few days earlier while visiting the Pantanal, a large tropical wetland in Central-West Brazil, where she bathed in rivers regularly. There was no significant past medical history. Vital signs were normal, and physical examination revealed suprapubic tenderness but was otherwise unremarkable. ... The patient was admitted for further investigations. The organism passed in urine was identified as a rat-tailed maggot, the larval form of the drone fly Eristalis tenax. Urinalysis revealed microscopic haematuria and nitrites, and urine culture was positive for Escherichia coli (>100 000 CFU/ml). Cystoscopy and abdominal-pelvic CT scan and MRI were unremarkable. A diagnosis was made of internal urinary myiasis due to E. tenax rat-tailed maggot, with secondary E. coli cystitis.