MEDICAL BAG
This month, a pair of particularly stomach-churning cases caused by errant insects, plus a potential new strain of syphilis and the dangers of stifling a sneeze
EXTREME NOSE TERROR
An unnamed Florida man turned up at the HCA Florida Memorial Hospital in Jacksonville in early February after he started feeling like “his whole face was on fire”. He had been suffering minor symptoms since October, but went to hospital when they suddenly became much worse. “Over a couple hours my face just started swelling, my lips swelled, I could hardly talk,” he said. “I couldn’t even get up to go to the bathroom without my nose starting to bleed.”
He was examined by ear, nose and throat specialist Dr David Carlson, who was shocked to find a large number of insect larvae, some the size of the end of his little finger, feeding on the flesh in the man’s nose and sinus cavity. “I knew he was in big trouble – there was erosion that was occurring near the skull base in very close proximity to his eye and his brain,” Carlson said. “They were right up against his skull base, right under the brain, had they gone through that it could have killed him.” He first attempted to remove the larvae by suction, but they were too firmly embedded and had to be pulled out one by one, more
“My face started swelling, my lips swelled, I could hardly talk”
than 150 in all.
It is a mystery how the patient could have ended up with such a large infestation of the nasal cavities, although he is a fisherman, and it is thought possible that it could be the result of poor hygiene while handling dead fish. The larvae have been sent off to an entomologist for identification, which should help with the diagnosis, while the patient says, “Before, I would rinse my hands in the river – now I’ll use cleaner to do a better job and not touch my nose or my hand.” huffpost.co.uk, 20 Feb 2024.
HUMAN FLY
Even more mysterious was a fly found deep inside a Missouri man’s intestine during a routine colon screening. Matthew Bechtold, the chief of Gastroenterology at the University of Missouri, who carried out the screening, said that the 63-year-old patient had no idea how the fly had got there. He had only consumed clear liquids the day before the procedure and while he had eaten pizza and lettuce for dinner two days previously, he did not remember a fly being in his food. Bechtold said he had prodded the fly and confirmed it was dead and described the discovery as “a very rare colonoscopy finding and mystery on how the intact fly found its way to the transverse colon.” He said it was unlikely that the fly had entered through the man’s mouth, as it would have been “degraded” by upper digestive enzymes and stomach acid on the way down, but was equally unlikely to have got there via the rectum. “If from the bottom, an opening must have been created long enough for the fly to fly undetected into the colon and somehow make its way to the middle part of the colon with no light in a very curvy, large intestine,” he explained.
This is not the first time an anomalous insect has been found in a human colon; there have been several instances of intact cockroaches showing up during colonoscopies, and in 2019 another colonoscopy turned up a ladybird in a patient’s intestine. In this case it is believed its journey to the 59-year-old man’s colon was facilitated by the gallon of polyethylene glycol laxative the patient had taken the day before to clear his gut for inspection. iflscience.com, 2 Aug 2021; sciencealert.com, 7 Nov 2023.
BETTER OUT THAN IN
A male patient in his 30s with a history of allergies and throat irritation ended up in Ninewells Hospital, Dundee, in severe pain after he pinched his nose and closed his mouth to stifle a sneeze while driving. Doctors examining him heard a cracking sound in his neck and found he did not have full control of his neck movements, so they scanned him and discovered he had torn a 2mm hole in his windpipe. The patient did not need surgical intervention and, after being kept in overnight for observation, he was sent home with painkillers and hay fever medication and told to avoid any strenuous physical activity for two weeks.
Attempting to stifle a sneeze can be extremely dangerous as sneezing increases pressure in the upper airway 20-fold and trapping it can cause significant damage. Spontaneous tracheal