A diabetic individual with post-COVID-19 mucormycosis complicated by severe myiasis: a case report

Abstract Myiasis is a tropical parasitic infestation prevalent among individuals with poor living conditions and immunocompromised states. We present a unique case of nasal and oral myiasis in a patient with diabetes mellitus and post-COVID-19 mucormycosis. Contrary to existing literature, this patient exhibited well-controlled diabetes mellitus, maintained through regular follow-ups and strict medication adherence. To our knowledge, myiasis in individuals with controlled diabetes mellitus has not been previously documented. This report may thus provide valuable insights for physicians in evaluating patients with post-mucormycosis status, irrespective of environmental or medical factors. Our study details the case of a 71-year-old male with a history of diabetes mellitus, who presented with persistent dry cough, nasal bleeding, right-sided facial pain and swelling, and intermittent right temporal headache. The patient had a known history of COVID-19-associated mucormycosis and had undergone a dental procedure six months prior. Oral cavity examination revealed erosion of teeth on the right side, with migrating maggot larvae in the right upper third molar space, the site of the previous dental extraction. He was managed conservatively with analgesics and turpentine oil. Endoscopic removal of maggots was attempted, a single dose of systemic Ivermectin was given, and prophylactic antibiotics were prescribed. He improved symptomatically and was thus discharged. Our study suggests that mucormycosis alone can be a potential risk factor for myiasis, and therefore, regular follow-up, early diagnosis, and intervention of individuals with post-mucormycosis status are necessary.