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Mycobacterium haemophilum and crusted scabies are rare cutaneous diseases reported in distinct immunocompromised hosts. M. haemophilum is a skin and soft tissue infection, whereas crusted scabies is an infestation of the skin. Whereas scabies infestation is readily diagnosed, M. haemophilum infection poses a diagnostic challenge due to its rarity as well as varied clinical and histologic presentations. Although both scabies infestation and M. haemophilum have been reported in the literature separately, to our knowledge no previous reports have described these diseases occurring simultaneously in an iatrogenically immunosuppressed patient. We report herein a rare case of concomitant M. haemophilum and scabies infestation in a 38-year-old woman with dermatomyositis on multiple immunosuppressive agents.

Introduction: Visceral artery aneurysms and pseudoaneurysm are uncommon vascular phenomena, with hepatic and splenic artery origins representing the most common sites, that have a high mortality if ruptured. Typically, these are asymptomatic incidental findings discovered on imaging. Gastroduodenal artery (GDA) pseudoaneurysms may present prior to rupture as obstructive jaundice. Case Description/Methods: A 40-year-old male with a history of chronic alcohol pancreatitis, hypertension, remote history of abdominal procedure who presented to an outside hospital with two-week history of right upper quadrant abdominal pain with radiation to the back, jaundice, nausea, poor oral intake, and weakness. Upper endoscopy showed erosive esophagitis with no varices and a small hiatal hernia. On examination he was noted to be encephalopathic with pallor and scleral icterus. Total bilirubin was 20.2mg/dL, direct 14.2, hemoglobin 6.8, WBC 18k, CT abdomen/pelvis revealed a 9.5 x 8.9 cm GDA pseudoaneurysm with contained hemorrhage causing gastric outlet obstruction and marked intra-and extrahepatic ductal dilation, at which point he was transferred to our tertiary level care center (Figure). He underwent GDA coil embolization and placement of percutaneous transhepatic cholangiography (PTC) drain with control of hemorrhage, progressive resolution of hyperbilirubinemia and encephalopathy. Discussion: GDA pseudoaneurysms are extremely rare forms of visceral aneurysms, often found incidentally or following rupture which worsens prognosis. Occasionally, GDA pseudoaneurysms will present as obstructive jaundice as in the case of this patient. Management of these rare vascular phenomena require a multidisciplinary team, with endovascular techniques as the preferred first line approach, to achieve favorable clinical outcomes.[1874] Figure 1. CT Abdomen and Pelvis with IV contrast demonstrating gastroduodenal (GDA) pseudoaneurysm with active hemorrhage causing mass effect and intra-and extrahepatic ductal dilation.