Vulvalmyiasis in a rural setting: A case report

Myiasis is the infestation of dipterous larvae in various body wounds and orifices. It occurs predominantly in rural areas and is associated with poor hygiene.Infestation at the vulvar area is however, an extremely rare occurrence.A 27 year old lady, presented to labour ward at Sri R.L.Jalappahospital and research center with severe vulvar pain, irritation of vulva and perineum for past 4-5 days. She had normal vaginal delivery and uneventful postnatal period, 3 weeks ago. On examination of the vulva with consent and chaperon, therewas an ulcer measuring 2X3 cms on the left side of the Mons pubis, with induration and edema around the ulcer. Further close examination revealed tiny maggots measuring about 2 to 3 mm coming out of the ulcer. The episiotomy wound was healthy. Cervix and vagina were healthy. She had very severe pain and needed parenteral opioid injections, she was given prophylactic antibiotics. Examination under anesthesia and exploration of the ulcer was done the following day, the wound had a honey comb appearance and maggots were seen coming out of the ulcer. Wound debridement was done. Post-operative recovery was uneventful, the ulcer healed by secondary intension. She was discharged with advice on personal hygiene to avoid re- infestation.