brazjinfectdis2016;20(4):399–400
w w w . e l s e v i e r . c o m / l o c a t e / b j i d
The Brazilian Journal of
INFECTIOUS DISEASES
Clinical image
Crusted scabies in a patient with lepromatous leprosy
Alexandra Peres Paim Pedra e Cal
a,b,∗, Cassio Porto Ferreira
a, José Augusto da Costa Nery
aaInstitutoOswaldoCruz(FIOCRUZ),AmbulatórioSouzaAraújo,RiodeJaneiro,RJ,Brazil
bPoliclínicaGeraldoRiodeJaneiro,RiodeJaneiro,RJ,Brazil
a r t i c l e i n f o
Articlehistory:
Received12April2016 Accepted18April2016 Availableonline13May2016
Crusted scabies (CS) is a very contagious rare skin infes- tation caused by Sarcoptes scabiei var hominis, an obligate humanparasite, transmittedbyskin-to-skincontact.1 Clin- ically, it can present with psoriasiform skin lesions in acral distribution with variable whitish scaling. It usually involves the subunguealarea with nail hyperkeratosisand dystrophy.2 A56-year-old man, alcoholic,presentedwith a seven-month history ofpruritus (withnocturnal exacerba- tion), weight loss and muscle weakness. The patient is a knowncaseoflepromatousleprosy(LL),diagnosed22years agowithirregulartreatment,neurologicaldamageanddefor- mities.Onexamination,hyperkeratosiswithcrustedlesions on hands and feet with severe nail dystrophy. We also noted anerythematous scaling eruption in the face, neck, scalp, trunk,and arms(Fig. 1). Laboratory resultsincluded
∗ Correspondingauthor.
E-mailaddress:ale.peres.paim@gmail.com(A.P.P.PedraeCal).
a negative HIV and HTLV-1 tests, skin scraping revealed the miteandskinsmearshowed abacteriologicalindexof 6+.Thepatientstartedmultidrugtherapyformultibacillary leprosyandoralantihistamines,keratolytics,topicalperme- thrin (5%), and repeateddoses ofivermectin(200g/kg)on the 1st, 2nd, 8th, 9th, and 15th day. CS is a highly con- tagious rare variant of scabies and is frequently found in immunocompromisedpatients,mentallyretarded,orphysi- callyincapacitatedindividuals.3Infestedindividualsandtheir close contactsshouldbe treatedatthe same time, evenif asymptomatic.1 There are few reported casesshowing the associationbetweenCSandLL.InBrazil,duetothehighnum- berofleprosy,physiciansshouldbeawareofthepossibilityof CSinleprosypatientswhodevelopwidespreadhyperkeratotic eruptions.
http://dx.doi.org/10.1016/j.bjid.2016.04.001
1413-8670/©2016ElsevierEditoraLtda.ThisisanopenaccessarticleundertheCCBY-NC-NDlicense(http://creativecommons.org/
licenses/by-nc-nd/4.0/).
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braz j infect dis.2016;20(4):399–400Fig.1–Clinicalmanifestationsofcrustedscabiesinfection(A)–(C)Hyperkeratoticdermatosiswithanacraldistributionand naildystrophy;(D)disseminatedexcoriations,crustsandscalingintheback;(E)and(F)leoninefacies,pruritusandscaling, alsocrustsintheear;(G)microscopicsectionofS.scabieimiteshowingsixlegsandthebiteapparatus.
Authors’ contributions
AlexandraPeresPaimPedraeCal,CassioPortoFerreiraand JoséAugustodaCostaNerycontributedtoclinicalcareand paperpreparation.
Conflicts of interest
Theauthorsdeclarenoconflictsofinterest.
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