Two Cases of Myiasis Associated with Malignancies in Patients Living in the Continental United States

Abstract

Myiasis is the infestation of humans with dipterous larvae. Traditionally, myiasis was thought to affect individuals living in tropical regions, however, several cases in temperate zones have been reported. We encountered two patients with histories of malignancies that presented with complaints of myiasis, in Chicago, in the spring and summer of 2016. The first patient, a 54-year-old female with a history of breast cancer, presented with complaints of maggots infesting her postsurgical chest wounds. She was diagnosed with sepsis, cellulitis, and wound myiasis. The second patient, a 63-year-old female with a history of recurrent ovarian cancer, presented with complaints of passing maggots vaginally and seeing worms mixed with her stools. She was diagnosed with internal urogenital myiasis. The first lesson that we learned from these cases is that myiasis can occur in individuals living in any part of the world. Second of all, for patients with accidental myiasis, a sample of the larvae should be sent for analysis to help guide the treatment. Third of all, myiasis has been associated with new or recurrent malignancies, and therefore a biopsy of the affected tissue should be sent for analysis. Finally, we learned that myiasis can serve as a form of tissue debridement; this coinciding benefit should not prevent the treatment of accidental myiasis.

Keywords: gynecological cancers; larvae; maggot therapy; malignant wound; myiasis.

Figure 1. The picture of necrotic lesions affecting the right mastectomy and left lumpectomy sites, two weeks after the treatment of myiasis and cellulitis.

Figure 2. The sagittal cross section from the computed tomography (CT) of the chest that demonstrates the extension of the soft tissue infection at the left lumpectomy and the right mastectomy sites into the sternum and mediastinum.

Figure 3. The sagittal cross section from the computed tomography (CT) of the chest that shows the extension of the wounds into the mediastinum.

Figure 4. The sagittal cross section from the computed tomography (CT) of the pelvis of the bilateral adnexal masses.

Figure 5. The image from the echocardiogram demonstrating a 2.1 x 2.2 cm thrombus in the right atrium.

Figure 6. The sagittal cross section from the computed tomography (CT) of the abdomen and pelvis, performed in 2009, illustrating one of the ovarian masses.

Figure 7. The additional image from the computed tomography (CT) of the abdomen and pelvis, performed in 2009, of the ovarian masses.

Figure 8. The sagittal cross section from the computed tomography (CT) of the abdomen and pelvis, performed in 2016, of the ovarian mass.

Figure 9. The additional image from the computed tomography (CT) of the abdomen and pelvis, performed in 2016, of the ovarian mass with extension into the colon.

Figure 10. The sagittal cross section from the magnetic resonance imaging (MRI) of the abdomen-pelvis, performed in 2016, of the ovarian mass.

Figure 11. The additional image from the magnetic resonance imaging (MRI) of the abdomen and pelvis, of the ovarian mass, which demonstrates that the mass extends into the colon.

Figure 12. The additional image from the magnetic resonance imaging (MRI) of the abdomen and pelvis demonstrating the abdominal mass.