We describe the case of an elderly female with total genital prolapse and superinfected uterine myasis. The successful treatment included mechanical extraction of the larvae, antibiotics, and ivermectin (this last one reported for the first time); along with the surgical correction of the prolapse.
Myasis is a parasitic infestation of humans or other vertebrates by fly larvae. Affecting skin and exposed necrotic tissue, colonization has also been described in natural cavities, especially ears, nostrils, gastrointestinal, and genitourinary tracts; and less frequently, involving the uterus. Usually, it is present in individuals from rural areas with deficient hygienic habits, psychiatric problems, and limited access to the health care system. The basis of the treatment lies on the mechanical removal of the larvae; recently, the use of ivermectin has been suggested. This last is an 80:20 avermectin B1a to B1b mixture, which are macrocyclic lactones produced by actinobacteria Streptomyces avermitilis, with broad antiparasitic properties, microfilaricide.
Case Report
An 82-year-old illiterate female attending gynecologic service at Valle University Hospital, Cali, Colombia, with total genital prolapse noted for the last 5 years. Four ulcers were observed in the prolapsed uterus, the biggest one with a diameter of 6 × 3 cm, with necrotic edges. These were cavitated and infested by live larvae, Sarcophagidae (fleshflies) vs Calliphoridae (blowflies) families; with fetid discharge and inflammation of adjacent tissue ( Figures 1 and 2 ). The patient had a body mass index (BMI) of 31, personal neglect, poor hygiene, without signs of senile dementia. Antecedents of one vaginal delivery without complications. No chronic pathology. She is originally from a rural area, but has been living in an urban area for the last 5 years, in an industrial zone far from animal breeding or sanitary landfills. She was hospitalized for 7 days, received intravenous ceftriaxone-metronidazole; oral ivermectin (drops at 0.6%, 1 drop per kilogram of body weight) and topical ivermectin. Additional treatment included mechanical extraction of larvae with forceps and daily washing of lesions until obtaining granulation tissue ( Figure 3 ). Posthospitalization, topical estrogen was applied on the genital prolapse for 1 month. Surgical correction of the genital prolapse was performed via vaginal hysterectomy with anterior and posterior colporrhaphy; a procedure without complications.
