A rare case report of penile myiasis in a catheterized patient

Penile myiasis is the infestation of the penile area with larvae of certain fly species, especially diptera. It is rare but can be a serious parasitic infestation that typically occurs in individuals with poor hygiene or those living in unsanitary conditions. Due to the non-specific and vague clinical presentation, it holds diagnostic difficulty.

A 76-year-old male with a prior history of benign prostatic enlargement, diabetes mellitus, and hypertension presented with a painless penile wound and sanguineous discharge. Debridement of the wound and an attempt to expel the larvae using turpentine oil were performed. Cystoscopic examination revealed larvae inside the urinary bladder, for which bladder irrigation with 0.9 % NaCl solution and administration of ivermectin were carried out. During a follow-up visit, circumcision was performed. Subsequent cystoscopy showed no larvae inside the urinary bladder.

Penile myiasis is rare with only few cases reported globally and no any cases reported from Nepal till now. Penile myiasis is associated with different risk factors like poor personal hygiene, debilitated patients, genital piercing, etc. but the exact incidences of each of the associated factors is not mentioned in the literature. Due to its rare occurrence, diagnosis and proper treatment of penile myiasis is challenging.

Proper history and clinical examination of the genitalia is vital in debilitated patients, if they present with swellings or discharge especially those with prolonged catheterization or a history of immunocompromised conditions such as diabetes.