We describe a case of nasal myiasis in an 89-year-old Brazilian patient affected by leprosy with severe nasal sequelae. An initial treatment comprising sinusectomy combined with nasal endoscope removed more than 300 larvae, supplemented by systemic treatment using oral and topical ivermectin and levofloxacin. Infestation recurred after 2 months, was treated similarly, and resolved completely. The case could be attributed to severe nasal leprosy sequelae, with a lack of sneezing reflex, painless ulceration, atrophic rhinitis ozenosa, and inability to clean the nose properly due to hand and nose impairment. This case illustrates the importance of long-term medical follow-up of patients with leprosy sequelae.