Cerebral myiasis in a schizophrenic patient

A 32-year-old female presented with a complaint of ulcerated lesions on her scalp for 15 days. They were associated with local swelling and sero-sanguineous discharge. The patient was a known case of schizophrenia, presented in a disoriented state. Examination of the head revealed multiple focal scalp defects (A, B) of each about 2 to 5 cm. The defects showed multiple live maggots in different stages of their lifecycle. Non contrast CT head was advised, which revealed extra-calvarial soft tissue swelling in bilateral parietal region with multiple focal areas of scalp discontinuity. Underlying skull bone was normal.