Waldorf, James C.

Background: Human myiasis, the infestation of tissues by dipterous larvae, commonly manifests as painful, raised skin lesions, particularly in tropical regions such as Latin America, where Dermatobia hominis (the human botfly) is a frequent cause. With increased international travel, cases of travel-related myiasis have become more prevalent, necessitating awareness among healthcare providers in non-endemic regions. Methods: We present a case of cutaneous myiasis in a 69-year-old male who returned to the United States from Belize. The patient exhibited a painful skin lesion on his right knee, initially suspected to be an insect bite. The diagnosis was confirmed through ultrasound imaging, which revealed the presence of a subcutaneous larva. Conservative larva removal efforts failed, leading to surgical extraction of the larva. Results: The surgical intervention successfully removed the larva in its entirety, with the wound healing well after the procedure. Pathological examination confirmed the larva as Dermatobia hominis. The patient experienced a satisfactory recovery, with no complications observed during follow-up. Conclusions: This case underscores the importance of considering myiasis in the differential diagnosis of patients presenting with painful skin lesions following travel to tropical regions. As globalization increases, healthcare providers should be vigilant in recognizing and appropriately treating travel-related diseases such as myiasis to ensure prompt and effective care.

Perineal leiomyosarcoma is an extremely rare and aggressive cancer with a high metastatic potential and no defined standard treatment. There are only a few (six) reported cases in the literature. We report the case of a 67-year-old woman with a perineal leiomyosarcoma arising at the same site of a previously resected superficial angiomyxoma. Initially, she was treated for a presumptive recurrence of angiomyxoma. As she did not respond to medical therapy, she underwent repeat surgical excision. Pathology revealed a high grade leiomyosarcoma, histologically strikingly distinct from the initial diagnosis. She received adjuvant local radiation therapy, and remains without evidence of recurrent disease 36 months after completion of all therapy. This is the first reported case of a high grade perineal leiomyosarcoma originating at the same site as a resected benign superficial angiomyxoma. Our case emphasizes the necessity of a prompt histological diagnosis in cases of presumed recurrent perineal angiomyxoma.