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So… this is something I never thought of and something you may never see in the USA… Myiasis… Maggot of the head!! We were stationed in Accident & Emergency when the patient was referred from a community clinic to the hospital for treatment and admission. Upon arrival the patient was having head pain and very hesitant to be examined.  While at the community clinic the area was dressed with gauze. Although hesitant the scalp was examined and we were shocked to see a tiny maggot poke its head out of the 1×1 cm wound and then retract back in. After examination labs were drawn, IV placed and patient was then admitted. This is obviously a condition that happens in tropical regions due the screw worm. Just thought I would share Until next time…. Wanda and Shanna

While in Port Antonio, we saw a baby for the concern of enlarged breasts.  Grandmother had recently started taking care of her so she didn’t know the specifics as to how long they had been enlarged and so forth.  We didn’t think much of her examination because in infants, breast hypertrophy can be related to stimulation from maternal hormones, and can persist for several months in girls. Prior to her leaving, grandmother mentioned that the older sister (who was also present during the visit) also had enlarged breasts.  Her question was, “Can this run in the family?”  On examination of the older sister we noticed a striking difference in the size of her breasts- Unilateral Gynecomastia. A common normal variant in breast development is the unilateral onset of enlargement, which can be misdiagnosed as a tumor.  Unilateral breast development can exist as long as 2 years before the other breast even becomes palpable.  Although pathologic breast conditions are rare in children, we sent our patient for further evaluation of the breast with ultrasound.  Our hope– to identify normal breast tissue and a normal variation of breast development, while ruling out a tumor, cyst or abscess.

– Your friendly neighborhood pediatricians, Shanna and Wanda