Chronic graft versus host disease (GVHD) is a less frequently seen disease that occurs post solid organ or bone marrow transplantation. Chronic GVHD occurring post blood transfusion is an even more uncommon disease. It can present either as a lichenoid disease or as a sclerodermatous disease involving multiple systems. In this article, we report a case of chronic graft versus host reaction occurring in skin secondary to blood transfusion.

Norwegian (crusted) scabies is a highly contagious form of scabies which can evolve into erythroderma at times. We herein report a case of a 29-year-old male patient, an established case of epidermolysis bullosa dystrophica (EBD), presented to us with asymptomatic generalized scaling and crusting of 2 months duration. On examination patient also had dystrophic nails, anonychia and joint contractures. With a high index of suspicion, a scraping for KOH mount had done, which showed numerous scabies mites, eggs and faecal pellets. The patient was started on weekly oral Ivermectin (200mcg/kg) and topical 5% permethrin application. There was dramatic response within 1-2 weeks. This case is presented to highlight the diagnostic challenge that erythroderma may be due to Norwegian scabies or the primary entity- epidermolysis bullosa dystrophica (EBD). The association of EBD and Norwegian scabies has been reported in literature. A simple bedside test like scraping can nail the diagnosis, provided there is a high index of suspicion.