J Arthropod-Borne Dis, June 2014, 8(1): 117–118 AM Alizadeh and N Zamani: Myiasis in an …

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Cases Report

Myiasis in an 89-Year-Old Man with Non-Hodgkin Lymphoma

Afshin Mohammad Alizadeh 1, *Nasim Zamani 2

1Departmentof Bone Marrow Transplantation, Taleghani Hospital, Shahid Beheshti
University of Medical Sciences, Tehran, Iran

2Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical
Sciences, Tehran, Iran

(Received 17 Nov 2012; accepted 27 July 2013)

Abstract
Myiasis is due to the opportunistic dipterous larvae feeding on viable or necrotic tissues of the host occurring

throughout the world. We report a case of oral myiasis in an immune-compromised patient suffering from non-
Hodgkin lymphoma. We would like to emphasize that such ectoparasitic infections may happen in immuno-
compromised patients and oral hygiene should be evaluated in all of these patients.

Keywords: lymphoma, myiasis, immune-compromised host, oral

Introduction

Myiasis is due to the opportunistic dipter-
ous larvae feeding on viable or necrotic tissues
of the host frequently occurring throughout the
world. Here we report a case of oral myiasis
in an immune-compromised patient suffering
from non-Hodgkin lymphoma to emphasize
the importance of paying attention to oral
hygiene in immune-compromised patients.

Case Report

An 89-year-old man with the previous
history of dementia and non-Hodgkin lympho-
ma presented with sudden initiation of tach-
ypnea, tachycardia, and decreased level of con-
sciousness. In physical examination, coarse
crackles were auscultated all over the lungs
and the patient was febrile. In intraoral ex-
amination, the following scheme was seen. He
was intubated and mechanically ventilated
due to hypoventilation and loss of protective
airway reflexes. In the laboratory evaluations,
no noticeable abnormality was detected except

for leukocytosis (WBC=16000) and CRP of 4+.
Our patient was with the previous history

of dementia and follicular lowgrade lympho-
ma of stage Ia on wait and watch follow-up.
On the diagnosis of myiasis, lidocaine spray
accompanying with spray of hydrogen perox-
ide 3% were applied for killing of the larvae.
The inter-denture spaces were filled with vas-
eline. The patient was intubated in order to pre-
vent further migration and aspiration of the
larvae. He was put on intravenous midazolam
with the dose of 1 mg per hour for maintenance
of unconsciousness. Cefepime and clindamycin
were initiated with the dose of 2g, BD and
600 mg, TDS, respectively. The patient died
7 days later from sepsis.

Discussion

Myiasis is due to the opportunistic dipterous
larvae feeding on viable or necrotic tissues of
the host (Sankari and Ramakrishnan 2010). Of
the many types of myiasis, furuncular myiasis

 *Corresponding author: Dr Nasim Zamani, E-mail:
nasim.zamani@gmail.com

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Published Online: December 18, 2013



J Arthropod-Borne Dis, June 2014, 8(1): 117–118 AM Alizadeh and N Zamani: Myiasis in an …

118

is the most common (Diaz 2009). Since oral
tissues are not permanently exposed to the
external environment, oral myiasis is less com-
mon than cutaneous myiasis (Rossi-Schnei-
der 2007). It has previously been reported in
dental extraction, nosocomial infection, drug
addiction, visits to tropical countries, psychi-
atric patients, and conditions that cause pro-
longed mouth opening including senility, al-
coholism, and mental retardation.

Fig. 1. Larvae in the necrotic maxillary bone, base
of the last molar tooth

Persistent mouth opening facilitates the dep-
osition of the eggs by the adult fly (Sankari
and Ramakrishnan 2010). Treatment of the
condition generally includes injection of
lidocaine into the draining lesions, occlusive
coating of vaseline (petroleum) ointment, clear
fingernail polishing, tobacco tar, and surgical

or vacuum extraction of the larvae in cases of
unsuccessful occlusive therapy (Diaz 2009).
However, after removal of the larvae, it seems
that the tissues recover with no subsequent
complications and further need for treatment
(Droma et al. 2007). This case shows the de-
velopment of an ectoparasitic infection in an
immunocompromised patient and shows the
importance of paying attention to oral hy-
giene in these patients.

Acknowledgements

The authors declare that there is no con-
flict of interest.

References

Diaz JH (2009) Myiasis and Tungiasis In:
Mandell GL, Bennett JE, Dolin R (Eds)
Principles and Practice of Infectious
Diseases, 7th edn. Vol 2. Elsevier Press,
Philadelphia, USA, pp. 3637–3638.

Droma EB, Wilamowski A, Schnur H, Yarom
N, Scheuer E, Schwartz E (2007) Oral
myiasis: a case report and literature re-
view. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod. 103: 92–96.

Rossi-Schneider T, Cherubini K, Yurgel LS,
Salum F, Figueiredo MA (2007) Oral
myiasis: A case report. J Oral Sci. 49:
85–88.

Sankari LS, Ramakrishnan K (2010) Oral
myiasis caused by Chrysomya bezziana.
J Oral Maxillofac Pathol. 14: 16–18.

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Published Online: December 18, 2013