A patient in his 70s, admitted to the cardiac intensive care unit with cardiogenic shock, unexpectedly presented with nasal myiasis during a workup for persistently elevated inflammatory markers. CT scans revealed sinusitis and bronchial secretions, while bronchoscopy identified mucus with positive pathogen testing. Nasal endoscopy was crucial in diagnosing myiasis, and immediate mechanical removal of larvae was performed. Definitive treatment involved surgical debridement, turbinectomy and sinus cleansing, leading to a successful recovery without complications. This case emphasises the importance of considering nasal myiasis as a rare but potential cause of sinusitis in critically ill patients, even in non-endemic regions. Early diagnosis using appropriate imaging and endoscopic techniques, followed by prompt treatment, is essential for preventing severe complications. Increased awareness among healthcare professionals is vital for the timely recognition and management of this condition in critical care settings.