Norwegian scabies in a malnourished young adult: a case report

Abstract

A 19-year-old male was admitted to the medical ward with complaints of fever and swelling of the ankle and wrist joints of about two weeks' duration. The patient developed hyperkeratotic lesions of the skin over the hands, elbow and back about three weeks after admission. Antistreptolysin O, rheumatoid factor, and Widal tests as well as Chickungunya, brucella, HIV and antinuclear antibodies were negative. Culture of blood sample and pus aspirate from the ankle and chest yielded a pure growth of Staphylococcus epidermidis. Potassium hydroxide (KOH) mount of the scrapings from crusted skin lesions showed plenty of adult mites, eggs and faecal pellets of Sarcoptes scabiei. A diagnosis of crusted scabies with secondary bacterial infection was made and the patient was treated successfully with oral ivermectin, topical permethrin and vancomycin.

Norwegian scabies mimicking rupioid psoriasis

“…1,6,7,8,9,10 Among this group, the weak immune response fails to contain the disease and there is no impulse to scratch, resulting in fulminant hyper-infestation. 2,4,6 …”

“…Therefore, this condition generally requires repeated application of topical and systemic scabicidal agents. 2,4 …”

“…1 Immunocompetent individuals rarely develop crusted scabies. 2 As a reaction to the massive infestation, the horny layer thickens, mimicking other dermatoses such as psoriasis, seborrheic dermatitis, Darier's disease, dermatitis herpetiformis and drug- induced eruptions. 3,4 Rupioid or ostraceous psoriasis is an extremely rare variety of psoriasis with few publications in the literature.…”

Complement inhibition by Sarcoptes scabiei protects Streptococcus pyogenes - An in vitro study to unravel the molecular mechanisms behind the poorly understood predilection of S. pyogenes to infect mite-induced skin lesions

“…In multiple clinical reports the colonisation of mite-infected skin with GAS [23], S . aureus [22, 24], and other pathogens [25, 26] has been thought to be the main cause of systemic infection and detrimental disease outcomes for patients with severe scabies.…”

Crusted scabies due to indiscriminate use of glucocorticoid therapy in infant

“…In most cases, it is associated with an underlying disease and mainly affects immunocompromised individuals due to conditions such as lymphoma, acquired immunodeficiency syndrome, immunosuppressive and corticosteroid treatment, malnutrition, institutionalization and mental illness. 3,4 It presents as thick, scaling, hyperkeratotic lesions, affecting the whole body, mainly the face, neck, scalp and subungual region. 5 Affected individuals harbor thousands of parasites, thus the disease is highly contagious.…”