Description

Several cases of obligatory wound myiasis have been reported in the medical literature.1–3 For a long time, such infestation was perceived as a complication of poor quality wound care in patients with chronic ulcers. There are only three cases of wound myiasis reported in the literature. Demirel et al reported on a 68-year-old male patient with larvae infestations of diabetic wound that were discovered during surgical debridement.3 Another two cases of traumatic larval infestation associated with Bowen carcinoma and with chronic leg ulcer were reported.3 Up to date, there is no report of chronic ulcer with massive larvae infestation as in this patient.

Figure 1 with video capture (video 1) demonstrates a massive larvae infestation of severe chronic ischaemic ulcer in a 60-year-old homeless male patient with HIV, who presented with unilateral leg pain without systemic or local signs of infection. The local examination of the ulcer site demonstrates a significant diamond-shaped ulcer 4.7 inch × 2.3 inches exposing the Achilles tendon and the surrounding granulation tissue with no evidence of local signs of infections.

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Figure 1

Myiasis infestation of chronic ulcer.

Management of chronic wound ulcer is usually prolonged and challenging. Therefore, different approaches have been implemented in wound management, including what is called maggot debridement therapy (MDT). MDT can improve debridement, disinfection, bacterial biofilm eradication, and ultimately wound healing.4 Consequently, therapeutic maggot debridement has been approved as a novel modality of ulcer treatment.5 Our patient’s circumstances of poor hygiene, homeless situation and severe peripheral vascular disease drastically increased his risk of repeated wound infection. However, the presence of the associated larvae infestation appears to help natural wound debridement and prevent bacterial infection.