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Casu martzu is a traditional Sardinian sheep milk cheese that contains live insect larvae (maggots). A variation of this cheese exists also in Corsica (France), where it is called casgiu merzu, and is especially produced in some Southern Corsican villages like Sartene.

Derived from pecorino, casu martzu goes beyond typical fermentation to a stage of decomposition, brought about by the digestive action of the larvae of the cheese fly of the Piophilidae family. These larvae are deliberately introduced to the cheese, promoting an advanced level of fermentation and breaking down of the cheese's fats. The texture of the cheese becomes very soft, with some liquid (called lgrima, Sardinian for "teardrop") seeping out. The larvae themselves appear as translucent white worms, roughly 8 mm (516 in) long.
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Casu martzu is considered by Sardinian aficionados to be unsafe to eat when the maggots in the cheese have died. Because of this, only cheese in which the maggots are still alive is usually eaten, although allowances are made for cheese that has been refrigerated, which results in the maggots being killed. When the cheese has fermented enough, it is often cut into thin strips and spread on moistened Sardinian flatbread (pane carasau), to be served with a strong red wine like cannonau. Because the larvae in the cheese can launch themselves for distances up to 15 centimetres (6 in) when disturbed, diners hold their hands above the sandwich to prevent the maggots from leaping.

Casu martzu is believed to be an aphrodisiac by Sardinians.

According to some food scientists, it is possible for the larvae to survive the stomach acid and remain in the intestine, leading to a condition called pseudomyiasis.

Because of European Union food hygiene-health regulations, the cheese has been outlawed, and offenders face heavy fines. However, some Sardinians organized themselves in order to make casu martzu available on the black market, where it may be sold for double the price of an ordinary block of pecorino cheese. As of 2019, the illegal production of this cheese was estimated as 100 tonnes (98 long tons; 110 short tons) per year, worth between 2-3 million.

Casu martzu is among several cheeses that are not legal in the United States.