Palliative Management of Advanced Breast Carcinoma Complicated by Myiasis: First Case Report From Bangladesh

Invasive ductal carcinoma (IDC) is the most common subtype of breast cancer. While malignant wounds are known to predispose patients to secondary infections, the co-occurrence of cutaneous myiasis in breast carcinoma remains rare. We report the first documented case of wound myiasis in a patient with advanced breast carcinoma in Bangladesh. A 52-year-old woman with HER2-positive IDC of the right breast, previously treated with mastectomy, chemotherapy, and radiotherapy in a tertiary care hospital of Dhaka, presented to the Department of Palliative Medicine at Bangladesh Medical University with severe chest wall pain, facial swelling, and a foul-smelling ulcerated wound on her right chest wall on mastectomy site, infested with live maggots. The patient had advanced stage 4 disease with extensive skin and bony metastasis, stage 3 lymphedema, and a Palliative Performance Scale score of 30%, indicating an estimated survival of 8 to 41 days. Approximately 650 larvae were removed over 3 days through manual extraction and irrigation using saline, metronidazole, and turpentine, followed by occlusive dressing with petroleum gauze. She was treated with morphine, flucloxacillin, ivermectin, and albendazole, which resulted in significant symptomatic relief. This case highlights the complex intersection of advanced malignancy, socioeconomic deprivation, poor hygiene, and parasitic infestation. Palliative care played a critical role in pain relief, wound management, and preserving dignity in her final days. This report underscores the importance of early recognition and integrated management of malignant wound myiasis, particularly in resource-constrained environments. It also draws attention to the broader psychosocial impacts of such conditions and the essential role of end-of-life care in mitigating suffering.