Hemorrhagic gingival and tracheopulmonary myiasis: literature review and case report of Chrysomya megacephala in a patient with HIV/AIDS and likely histoplasmosis.

Myiasis is a rare parasitic infestation caused by dipteran larvae, primarily from the Calliphoridae, Oestridae, and Sarcophagidae families. Though often benign, myiasis can lead to severe secondary infections. In this case report, we describe the first fatal case of gingival and tracheopulmonary myiasis caused by Chrysomya megacephala (Fabricius, 1794) (Diptera: Calliphoridae) in an HIV/AIDS patient with probable histoplasmosis. The patient, a 47-yr-old male from Manzanillo, Mexico, presented with systemic infection, pancytopenia, and multiple organ failure. Upon admission, oral larval infestation and severe gingival bleeding were evident, progressing to tracheal invasion. Despite treatment, the patient succumbed to shock and respiratory failure. Larvae identification was confirmed through morphological analysis and molecular techniques, revealing C. megacephala. This report underscores the need for rapid diagnosis and intervention in myiasis, particularly in immunocompromised individuals, and highlights the importance of awareness in endemic regions.