Anorectal Myiasis Caused by Cochliomyia hominivorax in a Septic Tank Worker

The term "myiasis" refers to the parasitic infestation by fly maggots in human tissue. Although cutaneous involvement is well documented, anorectal myiasis is exceedingly rare, particularly when caused by Cochliomyia hominivorax, The New World screwworm fly. We present the case of a 55-year-old male septic tank worker from a rural northern community of Honduras. The patient presented with hyperglycemia, perianal pain, discharge, and prolapsed hemorrhoids. Upon admission, an early evaluation led to a new diagnosis of diabetes type II. We arranged a surgical exploration in the operating theater under general anesthesia. During debridement and exploration, we found numerous larvas invading the anal mucosa and second-/third-degree hemorrhoids. The treatment included submucosal hemorrhoidectomy, larval extraction, systemic antibiotics, outpatient wound care, glycemic control, and a dose of ivermectin, all of which led to a full recovery. This case highlights the diagnostic and therapeutic challenges of myiasis in atypical anatomical sites, impaired wound healing in diabetic patients, and emphasizes occupational risk in low-sanitation environments.