An Unusual Case of Genital Myiasis in Nicaragua: A Multidisciplinary Approach in a Patient With Stage IV Pelvic Organ Prolapse.

Myiasis, a parasitic infestation caused by fly larvae in necrotic tissue, is rare in urban settings but can complicate conditions like advanced pelvic organ prolapse (POP). This report highlights the diagnostic and therapeutic challenges of myiasis in a patient with grade IV POP. An 85-year-old postmenopausal woman presented with a four-year history of vaginal mass protrusion, recent bleeding, foul discharge, and necrotic tissue. Examination revealed grade IV POP with left-sided necrotic tissue (4 × 4 cm) infested with larvae. Laboratory findings showed leukocytosis (17.57 × 10³/µL), elevated CRP (28.03 mg/dL), and a hemoglobin level of 14 g/dL. Management included surgical debridement, saline/chlorhexidine lavage, ivermectin, and broad-spectrum antibiotics (ceftriaxone/clindamycin), later adjusted to cefepime after cultures grew Escherichia coli and Sphingomonas paucimobilis. Imaging revealed bladder stones treated with pneumatic cystolithotripsy. Definitive surgery (vaginal hysterectomy, colpectomy, and perineoplasty) resolved the prolapse. This case emphasizes the importance of multidisciplinary care, early debridement, tailored antibiotics, and definitive surgery in managing complex myiasis with POP. It underscores the need for hygiene education and regular follow-up in high-risk patients.