Nasal Myiasis Mimicking Allergic Rhinitis in Immunocompetent Adults: Case Series of 14 Adults

Background: Human nasal myiasis is a rare zoonotic infection caused by Oestrus ovis with a non-specific clinical presentation that can mimic more common conditions such as allergic rhinitis. Objective: To report a series of nasal myiasis cases in immunocompetent individuals, emphasizing the clinical presentation and complementary investigations (endoscopic findings, parasitological identification, skin prick tests, and imaging studies) that facilitate differential diagnosis from allergic rhinitis and enable early treatment. Methods: We conducted a retrospective study including cases of nasal myasis diagnosed and managed at the ENT department of the Military Hospital of Tunis over an 18-year period (2007–2025). Demographic, clinical, diagnostic, and therapeutic data were analyzed. Results: The mean age was 43 years, with a female predominance. Most patients presented with acute rhinological symptoms initially suggestive of allergic rhinitis. Nasal endoscopy revealed larvae in 79% of cases with parasitological confirmation of Oestrus ovis. Facial CT scans performed in five cases (36%) were unremarkable. Management consisted of multiple daily nasal saline irrigations and albendazole, in association with oral corticosteroids and antihistamines, resulting in symptom resolution within an average of 4 days. Conclusions: Nasal myiasis should be considered in atypical or treatment-resistant rhinitis. Nasal endoscopy is essential for diagnosis.