Wound myiasis extending into the anterior mediastinum after a neglected self-inflicted chest stab wound: a case report

Introduction and importance: Wound myiasis is uncommon in high-income settings and usually occurs in neglected wounds in patients with impaired self-care or psychiatric illness. Mediastinal extension after penetrating chest trauma is exceptionally rare. Case presentation: A 68-year-old man with depression was found collapsed 6 days after leaving home with self-inflicted stab wounds to the neck and anterior chest. Numerous live larvae were present on the body surface and within the wounds. He was hypotensive with severe dehydration, hypernatremia, and acute kidney injury. Computed tomography showed anterior mediastinal air and pericardial fluid. Emergency exploration revealed a direct tract through the transected left sixth and seventh costal cartilages into the anterior mediastinum, with two live larvae on the pericardial surface. No pericardial or myocardial injury was identified. Larval removal, debridement, irrigation, and mediastinal drainage were performed. Broad-spectrum antimicrobial therapy was de-escalated according to culture results. Negative-pressure wound therapy with instillation and dwell time was followed by conventional negative-pressure wound therapy and split-thickness skin grafting. He was discharged on postoperative day 53. Clinical discussion: External examination may underestimate the depth of wound myiasis after penetrating trauma. Imaging and early operative exploration should be considered when a deep extension is suspected. Spontaneous myiasis should be regarded as a marker of severe wound neglect and contamination rather than as a therapeutic process. Conclusion: Mediastinal wound myiasis requires prompt larval removal, surgical source control, drainage, culture-directed antimicrobial therapy, and staged wound reconstruction. Graphical abstract available at: https://links.lww.com/IJSCR/A212