A rare case of bladder myiasis mimicking radiation cystitis: A first case report

A rare case of bladder myiasis mimicking radiation cystitis: A first case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A rare case of bladder myiasis mimicking radiation cystitis: A first case report 1) Dr. Mahendra Kumar, 2) Dr. Sujit Saikia, 3) Dr. Anup Kumar Das, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3253193/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background: Patients diagnosed to have cancer post treatment are prone to have recurrent disease. Regular follow up of these patients enables early recognition and treatment. It is imperative to obtain a tissue diagnosis prior to starting treatment. Case report: We present a rare case of bladder myiasis. A 51 year old woman was referred to our institution post total abdominal hysterectomy with bilateral salpingo-opherectomy in view of post-menopausal bleeding and biopsy suggestive of papillary endometrioid endometrial carcinoma. She received adjuvant radiation external beam radiotherapy in view of high intermediate risk group (LVSI positive). She was diagnosed to have pelvic recurrence 5 years later for which she received palliative radiation. She presented with recurrent radiation cystitis which was initiated managed conservatively. On further evaluation she was diagnosed to have a bladder mass on ultrasound. She underwent cystoscopy and biopsy of bladder mass which was reported as bladder myiasis and successfully treated with single dose of Ivermectin. Post treatment there was resolution of the bladder mass and she was kept on regular follow up after educating for hygiene maintenance. Conclusion: It is important to ensure regular follow up of patients treated for gynaecological cancers given their immunosuppression. Moreover proper evaluation of recurrences avoids the potential harmful side effects of chemotherapy and radiation. It is recommended to increase awareness for hygiene in cancer survivor patients’ predominantly female patients. Figures Figure 1 Figure 2 Introduction With advancement in treatment of various gynaecology cancers, proper follow up post treatment is very important. It plays an important role in detecting early recurrences and treatment of side effects of primary therapy.While recurrences are usually detected on imaging such as constrast enhanced computed tomography(CECT) it is imperative to obtain a tissue diagnosis before labelling the patient to have a recurrence. This enables accurate diagnosis of the patient and avoids the potential harmful side effects of chemotherapy and radiation. We report an unique case of bladder myiasis in the background of radiation cystitis diagnosed on evaluation of a bladder mass during follow up of an endometrial cancer patient treated by radiation. Case report Demographic details & medical history: A 51 years old postmenopausal lady, homemaker belonging to lower middle class of socioeconomic status by modified Kuppuswamy scale was reffered to our tertiary care institute. She had underwent total abdominal hysterectomy with bilateral salphingoophorectomy in 2015 in view of post menopausal bleeding and biopsy report suggestive of papillary endometriod endometrial carcinoma. Review of the biopsy report showed papillary endometriod carcinoma of endometrium with less than 50% myometrial invasion and Lymphovascular space invasion LVSI involvement. On discussion in Joint tumour board adjuvant radiation with external beam radiotherapy in view of high intermediate risk group(LVSI positive) was taken. The patient had completed radiation (EBRT − 50Gy in 25# and CVS 7Gy in 3#) till February 2016 following which she was on regular follow-up. During follow-up after a disease-free interval of 58 months, she had pelvic recurrence in December 2020 and was planned for palliative radiation therapy in the Joint tumour board. She had received 30Gy in 10# between 19/1/2021 to 02/02/2021. After completion of treatment, the patient was advised for regular follow up. Present illness & management In December 2021, the patient had mild, intermittent and scanty haematuria.. There was no history of fever, chills or rigor. She was advised to do a routine blood and urine examination. Blood workup was normal. USG KUB was suggestive of mild cystitis and significant residual volume of urine in the urinary bladder. Cystoscopy showed blood clots with multiple telangiectases predominately on the dome of the bladder. The patient was managed conservatively and there was resolution of symptoms. After six months, she came for a follow-up visit with complaints of haematuria. USG done was suggestive of a small polypoidal lesion in the urinary bladder (Fig. 1 ). Urologist opinion was sought for in view of the above findings. Cystoscopy-guided biopsy of the mass was done and histopathological examination suggested a maggot with no malignant tissue (Fig. 2 ). Species of larvae could not be identified. She received a single dose of ivermectin 12 mg per oral and oral antibiotics for UTI. 1 Repeat USG KUB was done after one month which was normal. The patient is on regular follow-up now and is asymptomatic. Discussion Urinary myiasis is associated with unhygienic conditions. The common factors are the lack of sanitation, urinating in dirty toilets causing flies to sit or bite the perineal area during urination, not using a mosquito net, low immunity, female patient and lower socioeconomic status. 2 In our patient lower socioeconomic status, diminished immunity due to prior radiation and unsanitary conditions were the contributory factors. It is reported that urogenital discharges attract flies around the external genital and urethral orifice. The patient had also received radiation therapy twice, first as an adjuvant therapy post-surgery in initial treatment and later due to recurrence, which caused foul-smelling discharge due to tissue necrosis. The larva may have passed upwards through the urethra into the urinary bladder. This would have caused cystitis and increased urination frequency, haematuria and lower abdominal pain. The differential diagnosis of haematuria were radiation cystitis, urinary infection or tumour recurrence in the bladder. So as a part of the initial workup, routine microscopy and urine culture and an ultrasound was advised. Urine examination was normal without haematuria, significant pus cells or parasitic infestation. Initial ultrasonography was normal. As there was no clinical evidence of recurrence the patient was kept on follow-up three monthly. Six months later she presented with recurrent haematuria and initial investigations were repeated. Ultrasonography showed a bladder growth at the dome of size 10x12 mm which was interpreted as a recurrence of disease in the urinary bladder and cystoscopy was advised. On cystoscopy, a polypoid lesion around 1 cm was noted, excised and sent for biopsy. Final histopathology showed edematous bladder mucosa and necrosis with fragments of an organism with a cuticular spine all around its body with morphology suggestive of maggots. There was no evidence of any tumour. Urinary myiasis is a rare uncommon finding even for an experienced urologist who performs cystoscopies. In the case of cancer survival patients any abnormal growth in any part of the body is an alarming sign and needs to be biopsied to confirm the diagnosis. Myiasis is an inoculation of flies larvae in the human body classified as cutaneous, gastrointestinal, nasopharyngeal, ocular and urinary. 3 Myiasis can be obligatory or facultative parasitosis. Cutaneous myiasis is the most common type whereas urinary myiasis is extremely rare since the perineal area is covered thereby the urethra and urinary tract are inaccessible to flies. Conditions such as unhygienic toilets, dirty clothes or necrotic tissue predispose to urinary myiasis and present as cystitis or urethritis. Larvae of Fannia scalaris are the most common cause of urinary myiasis. Other fly genera such as Musca , Sarcophaga , Lucilia , Wohlfahrtia and Calliphora are also associated with cases of urinary myiasis. 4 Urinary myiasis may be associated with underlying urinary tract pathology or surgical intervention. The pathology is due to inflammation and toxins secreted by the larvae which prevents healing and lead to progressive and continuous necrosis of the bladder wall. In this unique case we speculate that the patient was infected by the larvae due to the dirty vaginal discharge. The anatomical and physiological characteristics of the female urethra, low immunity due to malignancy and poor personal hygiene would have increased her likelihood of infection. Fortunately the parasite life cycle cannot be completed in the human body. Therefore when patients improve their immunity and sanitary conditions they recover quickly. Conclusion As discussed in this rare case, we recommend increasing awareness for hygiene in cancer survivor patients predominantly female patients and proper evaluation of recurrence cases, especially in doubtful situations. Declarations Ethical approval and consent to participate – Not applicable Consent for publication – Written informed consent had been obtained from the patient and care giver after thorough explanation about publication of case report Availability of data and materials – it will be available in our institute for 5 years. Competing interests – No. Funding – No Authors contributions – MK and DB formulated the concept of reporting this case. MK, DB, UB and DB prepared the whole manuscript. SK helped in finding out material regarding our case report. SS performed cystoscopy and urinary bladder biopsy. AK performed histopathological examination and formulated pathological diagnosis of bladder myiasis. Acknowledgement - KC helped in finding out various publication plateform and finalized to published in this journal. References Osorio J, Moncada L, Molano A, et al. Role of ivermectin in the treatment of severe orbital myiasis due to Cochliomyia hominivorax. Clin Infect Dis. 2006 Sep 15;43(6):e57–e59. Samuel MI, Taylor C. An unusual and unsettling place for a worm. Int J STD AIDS. 2010 Jul;21(7):524–525 pmid:20852207. Francesconi F, Lupi O. Myiasis. Clin Microbiol Rev . 2012;25(1):79–105. https://doi. org/10.1128/CMR.00010-11. Salimi M, Goodarzi D, Karimfar MH, Edalat H. Human urogenital myiasis caused by Lucilia sericata (Diptera: Calliphoridae) and Wohlfahrtia magnifica (Diptera: Sarcophagidae) in Markazi Province of Iran. Iranian J Arthropod Borne Dis. 2010;4:72–76. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 31 Aug, 2023 Editor assigned by journal 30 Aug, 2023 Submission checks completed at journal 14 Aug, 2023 First submitted to journal 10 Aug, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3253193","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":226185585,"identity":"7d545964-0b8d-42e7-98a9-1221e3d73678","order_by":0,"name":"1)\tDr. Mahendra Kumar","email":"data:image/png;base64,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","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"1)\tDr.","middleName":"Mahendra","lastName":"Kumar","suffix":""},{"id":226185587,"identity":"61fbc876-023d-4ee8-bcda-d6578efbb346","order_by":1,"name":"2)\tDr. Sujit Saikia","email":"","orcid":"","institution":"Central Nursing Home, Beltola, Guwahati, Assam","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"2)\tDr.","middleName":"Sujit","lastName":"Saikia","suffix":""},{"id":226185589,"identity":"1b19e934-154d-4b62-8cd9-0c1fcf87345d","order_by":2,"name":"3)\tDr. Anup Kumar Das","email":"","orcid":"","institution":"Arya wellness centre, Bangagarh, Guwahati,Assam","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"3)\tDr.","middleName":"Anup Kumar","lastName":"Das","suffix":""},{"id":226185591,"identity":"bbd7213b-71bd-4887-a196-25249fe25779","order_by":3,"name":"4)\tDr. Debabrata Barmon","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"4)\tDr.","middleName":"Debabrata","lastName":"Barmon","suffix":""},{"id":226185593,"identity":"5d0a749b-1829-441d-926b-294582f50ef6","order_by":4,"name":"5)\tDr. Upasana Baruah","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"5)\tDr.","middleName":"Upasana","lastName":"Baruah","suffix":""},{"id":226185596,"identity":"4a0e8858-2270-4604-bfc4-b6dd3f3c9ec7","order_by":5,"name":"6)\tDr. Dimpy Begum","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"6)\tDr.","middleName":"Dimpy","lastName":"Begum","suffix":""},{"id":226185597,"identity":"89c22d65-cc20-4c65-98b0-264ee56df2a1","order_by":6,"name":"7)\tDr. Sopouassi V. Nicholas King","email":"","orcid":"","institution":"Bhubaneswar Borooah Cancer Institute","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"7)\tDr.","middleName":"Sopouassi V. Nicholas","lastName":"King","suffix":""}],"badges":[],"createdAt":"2023-08-10 17:44:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3253193/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3253193/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":41794190,"identity":"e6bc3e85-0f16-4bb6-8061-20bb2190ad10","added_by":"auto","created_at":"2023-08-19 00:10:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":236931,"visible":true,"origin":"","legend":"\u003cp\u003ePelvic ultrasound showing urinary bladder growth\u003c/p\u003e","description":"","filename":"figure1pelvicultrasoundshowingurinarybladdergrowth.png","url":"https://assets-eu.researchsquare.com/files/rs-3253193/v1/be31ba17d1de916902e67e8b.png"},{"id":41794189,"identity":"b1e858cd-d8d9-441e-994f-5c8285b6b21d","added_by":"auto","created_at":"2023-08-19 00:10:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":363500,"visible":true,"origin":"","legend":"\u003cp\u003eH \u0026amp; E showing maggot on bladder growth tissue\u003c/p\u003e","description":"","filename":"figure2HEshowingmaggotonbladdergrowth.png","url":"https://assets-eu.researchsquare.com/files/rs-3253193/v1/fe9e771020a1069b5b023e50.png"},{"id":41794192,"identity":"660ef11a-b7b3-4f6d-b49b-fa5ac1284bf4","added_by":"auto","created_at":"2023-08-19 00:10:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1002664,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3253193/v1/f94018df-7ab4-4570-8c04-5e9c8f812ee6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A rare case of bladder myiasis mimicking radiation cystitis: A first case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith advancement in treatment of various gynaecology cancers, proper follow up post treatment is very important. It plays an important role in detecting early recurrences and treatment of side effects of primary therapy.While recurrences are usually detected on imaging such as constrast enhanced computed tomography(CECT) it is imperative to obtain a tissue diagnosis before labelling the patient to have a recurrence. This enables accurate diagnosis of the patient and avoids the potential harmful side effects of chemotherapy and radiation. We report an unique case of bladder myiasis in the background of radiation cystitis diagnosed on evaluation of a bladder mass during follow up of an endometrial cancer patient treated by radiation.\u003c/p\u003e"},{"header":"Case report","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDemographic details \u0026amp; medical history:\u003c/h2\u003e \u003cp\u003eA 51 years old postmenopausal lady, homemaker belonging to lower middle class of socioeconomic status by modified Kuppuswamy scale was reffered to our tertiary care institute. She had underwent total abdominal hysterectomy with bilateral salphingoophorectomy in 2015 in view of post menopausal bleeding and biopsy report suggestive of papillary endometriod endometrial carcinoma. Review of the biopsy report showed papillary endometriod carcinoma of endometrium with less than 50% myometrial invasion and Lymphovascular space invasion LVSI involvement. On discussion in Joint tumour board adjuvant radiation with external beam radiotherapy in view of high intermediate risk group(LVSI positive) was taken. The patient had completed radiation (EBRT \u0026minus;\u0026thinsp;50Gy in 25# and CVS 7Gy in 3#) till February 2016 following which she was on regular follow-up.\u003c/p\u003e \u003cp\u003eDuring follow-up after a disease-free interval of 58 months, she had pelvic recurrence in December 2020 and was planned for palliative radiation therapy in the Joint tumour board. She had received 30Gy in 10# between 19/1/2021 to 02/02/2021. After completion of treatment, the patient was advised for regular follow up.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePresent illness \u0026 management\u003c/h3\u003e\n\u003cp\u003eIn December 2021, the patient had mild, intermittent and scanty haematuria.. There was no history of fever, chills or rigor. She was advised to do a routine blood and urine examination. Blood workup was normal. USG KUB was suggestive of mild cystitis and significant residual volume of urine in the urinary bladder. Cystoscopy showed blood clots with multiple telangiectases predominately on the dome of the bladder. The patient was managed conservatively and there was resolution of symptoms.\u003c/p\u003e \u003cp\u003eAfter six months, she came for a follow-up visit with complaints of haematuria. USG done was suggestive of a small polypoidal lesion in the urinary bladder (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Urologist opinion was sought for in view of the above findings. Cystoscopy-guided biopsy of the mass was done and histopathological examination suggested a maggot with no malignant tissue (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Species of larvae could not be identified. She received a single dose of ivermectin 12 mg per oral and oral antibiotics for UTI.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Repeat USG KUB was done after one month which was normal. The patient is on regular follow-up now and is asymptomatic.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUrinary myiasis is associated with unhygienic conditions. The common factors are the lack of sanitation, urinating in dirty toilets causing flies to sit or bite the perineal area during urination, not using a mosquito net, low immunity, female patient and lower socioeconomic status.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e In our patient lower socioeconomic status, diminished immunity due to prior radiation and unsanitary conditions were the contributory factors.\u003c/p\u003e \u003cp\u003eIt is reported that urogenital discharges attract flies around the external genital and urethral orifice. The patient had also received radiation therapy twice, first as an adjuvant therapy post-surgery in initial treatment and later due to recurrence, which caused foul-smelling discharge due to tissue necrosis. The larva may have passed upwards through the urethra into the urinary bladder. This would have caused cystitis and increased urination frequency, haematuria and lower abdominal pain.\u003c/p\u003e \u003cp\u003eThe differential diagnosis of haematuria were radiation cystitis, urinary infection or tumour recurrence in the bladder. So as a part of the initial workup, routine microscopy and urine culture and an ultrasound was advised. Urine examination was normal without haematuria, significant pus cells or parasitic infestation. Initial ultrasonography was normal. As there was no clinical evidence of recurrence the patient was kept on follow-up three monthly. Six months later she presented with recurrent haematuria and initial investigations were repeated. Ultrasonography showed a bladder growth at the dome of size 10x12 mm which was interpreted as a recurrence of disease in the urinary bladder and cystoscopy was advised. On cystoscopy, a polypoid lesion around 1 cm was noted, excised and sent for biopsy. Final histopathology showed edematous bladder mucosa and necrosis with fragments of an organism with a cuticular spine all around its body with morphology suggestive of maggots. There was no evidence of any tumour.\u003c/p\u003e \u003cp\u003eUrinary myiasis is a rare uncommon finding even for an experienced urologist who performs cystoscopies. In the case of cancer survival patients any abnormal growth in any part of the body is an alarming sign and needs to be biopsied to confirm the diagnosis.\u003c/p\u003e \u003cp\u003eMyiasis is an inoculation of flies larvae in the human body classified as cutaneous, gastrointestinal, nasopharyngeal, ocular and urinary.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e Myiasis can be obligatory or facultative parasitosis. Cutaneous myiasis is the most common type whereas urinary myiasis is extremely rare since the perineal area is covered thereby the urethra and urinary tract are inaccessible to flies.\u003c/p\u003e \u003cp\u003eConditions such as unhygienic toilets, dirty clothes or necrotic tissue predispose to urinary myiasis and present as cystitis or urethritis. Larvae of \u003cem\u003eFannia scalaris\u003c/em\u003e are the most common cause of urinary myiasis. Other fly genera such as \u003cem\u003eMusca\u003c/em\u003e, \u003cem\u003eSarcophaga\u003c/em\u003e, \u003cem\u003eLucilia\u003c/em\u003e, \u003cem\u003eWohlfahrtia\u003c/em\u003e and \u003cem\u003eCalliphora\u003c/em\u003e are also associated with cases of urinary myiasis.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eUrinary myiasis may be associated with underlying urinary tract pathology or surgical intervention. The pathology is due to inflammation and toxins secreted by the larvae which prevents healing and lead to progressive and continuous necrosis of the bladder wall.\u003c/p\u003e \u003cp\u003eIn this unique case we speculate that the patient was infected by the larvae due to the dirty vaginal discharge. The anatomical and physiological characteristics of the female urethra, low immunity due to malignancy and poor personal hygiene would have increased her likelihood of infection. Fortunately the parasite life cycle cannot be completed in the human body. Therefore when patients improve their immunity and sanitary conditions they recover quickly.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAs discussed in this rare case, we recommend increasing awareness for hygiene in cancer survivor patients predominantly female patients and proper evaluation of recurrence cases, especially in doubtful situations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003col\u003e\n \u003cli\u003eEthical approval and consent to participate \u0026ndash; Not applicable\u003c/li\u003e\n \u003cli\u003eConsent for publication \u0026ndash; Written informed consent had been obtained from the patient and care giver after thorough explanation about publication of case report\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAvailability of data and materials \u0026ndash; it will be available in our institute for 5 years.\u003c/li\u003e\n \u003cli\u003eCompeting interests \u0026ndash; No.\u003c/li\u003e\n \u003cli\u003eFunding \u0026ndash; No\u003c/li\u003e\n \u003cli\u003eAuthors contributions \u0026ndash; MK and DB formulated the concept of reporting this case. MK, DB, UB and DB prepared the whole manuscript. SK helped in finding out material regarding our case report. SS performed cystoscopy and urinary bladder biopsy. AK performed histopathological examination and formulated pathological diagnosis of bladder myiasis.\u003c/li\u003e\n \u003cli\u003eAcknowledgement - KC helped in finding out various publication plateform and finalized to published in this journal.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOsorio J, Moncada L, Molano A, et al. Role of ivermectin in the treatment of severe orbital myiasis due to Cochliomyia hominivorax. Clin Infect Dis. 2006 Sep 15;43(6):e57\u0026ndash;e59.\u003c/li\u003e\n \u003cli\u003eSamuel MI, Taylor C. An unusual and unsettling place for a worm. Int J STD AIDS. 2010 Jul;21(7):524\u0026ndash;525 pmid:20852207.\u003c/li\u003e\n \u003cli\u003eFrancesconi F, Lupi O. Myiasis. \u003cem\u003eClin Microbiol Rev\u003c/em\u003e. 2012;25(1):79\u0026ndash;105. https://doi. org/10.1128/CMR.00010-11.\u003c/li\u003e\n \u003cli\u003eSalimi M, Goodarzi D, Karimfar MH, Edalat H. Human urogenital myiasis caused by Lucilia sericata (Diptera: Calliphoridae) and Wohlfahrtia magnifica (Diptera: Sarcophagidae) in Markazi Province of Iran. Iranian J Arthropod Borne Dis. 2010;4:72\u0026ndash;76.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-3253193/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3253193/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground:\u003c/p\u003e\n\u003cp\u003ePatients diagnosed to have cancer post treatment are prone to have recurrent disease. Regular follow up of these patients enables early recognition and treatment. It is imperative to obtain a tissue diagnosis prior to starting treatment.\u003c/p\u003e\n\u003cp\u003eCase report:\u003c/p\u003e\n\u003cp\u003eWe present a rare case of bladder myiasis. A 51 year old woman was referred to our institution post total abdominal hysterectomy with bilateral salpingo-opherectomy in view of post-menopausal bleeding and biopsy suggestive of papillary endometrioid endometrial carcinoma. She received adjuvant radiation external beam radiotherapy in view of high intermediate risk group (LVSI positive). She was diagnosed to have pelvic recurrence 5 years later for which she received palliative radiation. She presented with recurrent radiation cystitis which was initiated managed conservatively. On further evaluation she was diagnosed to have a bladder mass on ultrasound. She underwent cystoscopy and biopsy of bladder mass which was reported as bladder myiasis and successfully treated with single dose of Ivermectin. Post treatment there was resolution of the bladder mass and she was kept on regular follow up after educating for hygiene maintenance.\u003c/p\u003e\n\u003cp\u003eConclusion:\u003c/p\u003e\n\u003cp\u003eIt is important to ensure regular follow up of patients treated for gynaecological cancers given their immunosuppression. Moreover proper evaluation of recurrences avoids the potential harmful side effects of chemotherapy and radiation. It is recommended to increase awareness for hygiene in cancer survivor patients’ predominantly female patients.\u003c/p\u003e","manuscriptTitle":"A rare case of bladder myiasis mimicking radiation cystitis: A first case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-08-19 00:10:13","doi":"10.21203/rs.3.rs-3253193/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-09-01T03:25:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-08-30T06:28:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-08-14T07:23:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2023-08-10T17:29:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8632b8d0-3c87-4427-86f6-b5ccce442595","owner":[],"postedDate":"August 19th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2023-12-11T07:14:46+00:00","versionOfRecord":[],"versionCreatedAt":"2023-08-19 00:10:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3253193","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3253193","identity":"rs-3253193","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}