Adjunctive use of Maggot Debridement Therapy in the treatment of equine cutaneous pythiosis: A case report

Equine cutaneous pythiosis, caused by Pythium insidiosum , is a severe disease in tropical and subtropical regions, often leading to progressive granulomatous lesions with poor response to conventional therapies. Standard treatment includes surgical excision and immunotherapy, but recurrence is common, particularly in distal limb lesions. Maggot Debridement Therapy (MDT) with disinfected Lucilia cuprina larvae provides selective debridement, microbial control, and stimulation of granulation, representing a potential adjunctive option. This report describes the successful use of MDT combined with immunotherapy in a 5-year-old Criollo mare with a refractory lesion near the left hock. Despite surgical curettage and Pitium-Vac® immunotherapy, the lesion progressed until two MDT applications were performed. Rapid debridement was achieved, with effective removal of necrotic tissue including kunkers, resolution of exudation, and stimulation of granulation tissue formation. Continued immunotherapy led to complete wound healing and hair regrowth. These findings highlight MDT as a valuable, minimally invasive adjunct in equine pythiosis management, warranting further investigation. • First successful use of Maggot Debridement Therapy in equine pythiosis. • Surgery and Pitium-Vac® immunotherapy alone failed to control the lesion. • Two Lucilia cuprina larval applications achieved rapid wound debridement. • Immunotherapy plus MDT led to full healing, hair regrowth, and recovery. • MDT is a minimally invasive and effective adjunct for refractory pythiosis.