Myiasis in a neglected case of generalized erythrodermic pemphigus foliaceus

{Figure 1} The patient was a known case of pemphigus foliaceus and insulin-dependent diabetes mellitus since 2 years [Figure 2a] and [Figure 2b] and had received treatment including dexamethasone-cyclophosphamide pulse therapy only irregularly. Multiple ulcers measuring 1 to 4 cm in diameter with yellowish necrotic slough and maggots were present on lower abdomen, right side of the neck [Figure 3], left supraorbital area, right hand and right thigh. {Figure 3} Laboratory investigations revealed mild anemia (hemoglobin - 10.2g/dl), neutrophilic leukocytosis (white blood cell count - 17,200/mm [3]), low serum total proteins (4.2 g/dl), raised liver enzymes (serum glutamic oxaloacetic transaminase/serum glutamic pyruvic transaminase - 53/43 IU) and low serum sodium levels. Patient was administered intravenous fluids, antibiotics, oral hematinics and povidone-iodine gauze dressing and emollient application on scaly areas of the body with moxifloxacin eye drops. [3] Various agents used to suffocate and paralyze the larvae are chloroform in olive oil, turpentine oil, petroleum jelly, liquid paraffin, beeswax, resins, glue, adhesive tape, nail polish, chewing gum, pork fat, polymyxin B sulfate ointment, ether, 1% lidocaine and pilocarpine. Myiasis has been reported secondary to dermatological conditions such as giant squamous cell carcinoma,[4] basal cell carcinoma, cutaneous melanoblastoma, Bowen's disease, following radiotherapy...