Spontaneous cervical emphysema occurs in the absence of previous disorders or intiating factors and often poses a challenge in establishing an etiology at presentation. We report a 23 year old lady who presented with extensive subcutaneous emphysema in which a clear etiology was not evident during the initial presentation.

We are reporting a case of a gentleman referred to a tertiary care center for epistaxis associated with maggots in the nose and was found to have a nasal septal perforation. He underwent investigations with histopathologic analysis and skin slit smear to obtain a diagnosis. The patient received multidisciplinary management including endoscopic removal of the maggots and biopsies obtained from both the nasal septum and leg ulcers and subsequently anti leprosy medication.