Neglect leads to extremes: maggots and malignancy in a case of discoid lupus erythematosus

Abstract

Discoid lupus erythematosus (DLE) is a chronic form of cutaneous lupus erythematosus that runs an indolent course. The rare complications of DLE include scarring, mutilation, non-healing ulceration, cicatricial alopecia and malignancy. DLE progresses to systemic lupus erythematosus (SLE) in around 5% of localized cases and 22% of generalized cases. We report a case of DLE, presenting with a six-month history of ulcerated fungating plaques and small crusted nodules superimposed on DLE plaques over both the forearms. Two weeks prior to the presentation, maggots were also noticed on these plaques. Skin biopsies from these lesions were suggestive of squamous cell carcinoma (SCC) and keratoacanthoma. A wide surgical excision of the tumor followed by partial split-thickness skin grafting was performed with complete healing of the lesions. No recurrence has been noted 18 months from follow-up.

Cutaneous myiasis in skin cancer and malignant wounds: a systematic review

“…The most reported countries were India (22.1%), Brazil (25.4%), the United States (12.3%), Iran (7.4%), Spain (6.6%), and Turkey (5.7%). Concerning Colombia, only two cases were reported, although there may be a subregistration of these cases, just as in other countries as well 5–7,17–104 …”

“…The median age was 65 years old, and the average was 64 years (Tables ). Regarding gender, male was the most frequent one with 84 cases (68.9%), women reached 33 cases (27%), and only five subjects had unknown gender specification 5–7,17–104 …”

“…1). 5–7,17–104 A case series of Sowani et␣al 98 . with 83 patients was excluded from our study due to severe limitations in the eligibility methods, lack of precision in the clinical findings, and lack of histopathological confirmation.…”

“…The species classification can also vary according to its biological feeding behavior. The reader must be careful with the biological behavior of the larvae in tumor wounds 1–11,13–114 …”

Myiasis

“…This parasitic larva of fly lives on the debris and necrotic tissue. Diabetes, immunosuppression, and poor hygiene, in a hot climate and tropical countries are the main risk factors. Management is wound debridement and disinfection along with controlling the risk factors and treating the underlying cause.…”