Norwegian scabies in a malnourished young adult: a case report

Girija Subramaniam,Jeyakumari Duraipandian,Karthikeyan Kaliaperumal,Gopal Rengasamy

doi:10.3855/jidc.578

Girija Subramaniam, Jeyakumari Duraipandian + Show 2 more

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https://doi.org/10.3855/jidc.578

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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.

Highlights

Human scabies is a contagious cutaneous infestation caused by the ectoparasite Sarcoptes scabiei var. hominis [1]
We report here a case of Norwegian scabies in a malnourished adult with probable secondary bacterial infection and sepsis
Hyperkeratotic and crusted lesions appeared over the elbow, palms and back approximately two weeks after admission, which was noticed by the treating physician on routine examination. [Figures 2a, 2b] Scrapings of the lesions showed plenty of adult mites, eggs and faecal pellets of Sarcoptes scabiei by KOH mount (Figures 1a and 1b)

Summary

Introduction

Human scabies is a contagious cutaneous infestation caused by the ectoparasite Sarcoptes scabiei var. hominis [1]. Norwegian scabies (crusted scabies, hyperkeratotic scabies) is a clinically distinct and highly contagious form of scabies. Patients with diseases such as leprosy, immune deficiency disorders, malnutrition, HIV, and malignancy, as well as the elderly and those with Down’s Syndrome and mental retardation, are more prone to develop Norwegian scabies [3]. Crusted scabies is associated with an increased morbidity and mortality because of the frequent occurrence of secondary bacterial infections and sepsis [5].

Results

Conclusion