Abstract

Scabies is a contagious parasitic skin disease caused by Sarcoptesscabiei. Crusted scabies is a severe form of scabies that usually occurs in immune compromised patients. We report an uncommon case of crusted scabies in a woman followed forsystemic lupus erythematosus with severe and persistent lymphocytopenia.

Keywords: Crusted scabies; Systemic lupus erythematosus; Ivermectin; Immunosuppression.

Abbreviations: SLE: Systemic Lupus Erythematosus.

Citation: Raiteb M, Chahbi Z, Moutaj R, Badaoui M, Qacif H, et al. Crusted scabies in a woman with systemic lupus erythematosus. J Clin Images Med Case Rep. 2023; 4(5): 2421.

Clinical image description

A 32-year-old Moroccan woman with a 2-year history of Systemic Lupus Erythematosus (SLE) was hospitalized in our department for chronic fever, profound asthenia, and mildly itchy generalized skin lesions. The woman had a medical history of persistent severe lymphocytopenia, diabetes, and vitiligo. She was receiving corticosteroids and hydroxychloroquine as therapy for SLE.

The cutaneous lesions were generalized involving the limbs, trunk, head, and neck and they were mildly pruritic, scaly, and crusty on an erythematous background (Figure 1). She had profound lymphocytopenia at 440 cells/mm3 and a normal eosinophil count.

The appearance, distribution, and itchy character of the lesions were consistent with crusted scabies and the microscopicexamination of skin samples showed multiple mites, eggs, and feces confirming the diagnosis of crusted scabies (Figure 2). The woman received a combination of oral ivermectin 200 μg/kg/dose on days 1, 2, 8, and 15 and a daily topical treatment by Benzyl benzoate, which allowed a good clinical outcome (Figure 3) and negative microscopic tests on the skin samples after fifteen days of treatment.

Scabies is a contagious parasitic skin disease caused by Sarcoptes scabiei var homini. It was added to the World Health Organization’s list of neglected tropical diseases in 2017 [1]. We share this case to emphasize this uncommon association of SLE and crusted scabies as well as the clinical appearance of the skin lesions in this association. Due to the lack of immune response, crusted scabies is characterized by mild or absent pruritus [2]. It should be differentiated, as in our case, from cutaneous manifestations of SLE and several other diagnoses, including psoriasis and hyperkeratotic eczema [3].

Immunosuppression and chronic diseases like diabetes constitute risk factors for the occurrence of crusted scabies [2]. In our case the patient presented several risk factors represented by SLE and its severe lymphocytopenia, corticosteroid therapy, and diabetes.

Declarations

Patient consent: The authors certify that they have obtained all appropriate patient consent forms.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

References

1. Skayem C, Askour M, Gary C, Hemery F, Mahé E, et al. Severe Scabies: A French Multi-centre Study Involving 95 Patients with Crusted and Profuse Disease and Review of the Literature. Acta Derm Venereol. 2023; 103: 5351.
2. Sunder kötter C, Wohlrab J, Hamm H. Scabies: Epidemiology, Diagnosis, and Treatment. DtschArzteblatt Int. 2021; 118: 695–704.
3. Niode NJ, Adji A, Gazpers S, Kandou RT, Pandaleke H, et al. Crusted Scabies, a Neglected Tropical Disease: Case Series and Literature Review. Infect Dis Rep. 2022; 14: 479–491.