An unusual case of an infected preauricular pit in a child

Preauricular pits/sinuses (PPS) are common congenital anomalies found in infants and children. Acutely infected PPS may present with cellulitis, furunculosis, or abscess formation. We present a case of a child, with a suspected infected PPS and localized furunculosis whose infection was recalcitrant to standard antibiotics and no recent travel history. On exam, a preauricular (PA) circular puncta with localized cellulitis, pruritus, and tenderness was found. During operative exploration, the PA infection was found to represent cutaneous furuncular myiasis (FM) from a botfly larva. This case highlights the need to consider FM in children, who present with atypical head and neck infections recalcitrant to standard therapy.