Norwegian scabies in an infant with acquired immunodeficiency syndrome

A 6-month-old infant with acquired immunodeficiency syndrome (AIDS) and typical scabies subsequently developed Norwegian scabies, with deterioration of clinical status. The infestation spread to several health care workers who were in close contact with the patient, despite standard isolation precautions. In the rapidly growing hospitalized pediatric AIDS population, Norwegian scabies should be considered in the differential diagnosis of eczematous or seborrheic dermatitis.     

Sepsis associated with Norwegian scabies in patients with acquired immunodeficiency syndrome.

A review of the literature reveals that of the eight reported cases of patients with acquired immunodeficiency syndrome acquiring Norwegian scabies, three of these have been complicated by sepsis. We describe such a patient who contracted sepsis from Pseudomonas aeruginosa. We propose that the fissures often seen in severe cases of Norwegian scabies may serve as a port of entry for bacteria, thus placing these patients at a high risk for sepsis. We also believe that empiric antibiotic treatment is justified in these patients and that the choice of agent should be based on the institution's bacterial flora profile.     

Streaky pigmentation in a patient with acquired immune deficiency syndrome (AIDS)

We report a case of hyperpigmentation due to bleomycin treatment in a patient with acquired immune deficiency syndrome (AIDS). Although this type of hyperpigmentation has been previously seen in patients with cancer who are receiving bleomycin, this is, to our knowledge, the first reported case of bleomycin-induced hyperpigmentation in an AIDS patient and should be added to the growing list of cutaneous eruptions seen in these patients.     

Post-kala-azar dermal leishmaniasis as an immune reconstitution inflammatory syndrome in a patient with acquired immune deficiency syndrome

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) observed mainly in Sudan and India where it follows treated VL in 50% and 10% of cases, respectively. We report a 46-year-old patient with acquired immune deficiency syndrome who, 7 months after diagnosis of VL, developed PKDL and uveal leishmaniasis following HAART-induced immune recovery. In southern Europe PKDL seems to be an emerging clinical presentation among human immunodeficiency virus (HIV)-infected patients experiencing HAART-induced immune recovery after a previous diagnosis of VL. The best treatment among HIV-infected patients remains to be determined.     

Norwegian scabies in Bloom's syndrome.

Norwegian scabies is an unusual Sarcoptes scabiei infestation. It has been reported often in patients who are either severely debilitated or who have congenital or iatrogenic suppression of their immune responses. We report the occurence of Norwegian scabies in a 13-year-old boy with Bloom's syndrome who had impaired humoral and cell-mediated immunity.     

Crusted (Norwegian) scabies in a patient with dystrophic epidermolysis bullosa

A 13-year-old girl with severe non-mutilating recessive dystrophic epidermolysis bullosa (EB) was admitted to hospital because of a Staphyloccus aureussepsos, deterioration of her general condition and worsening of her skin disease, which itched severely. In addition to the blisters and erosions normally seen, she was covered from head to toe with scales and hyperkeratotic crusts. Despite intensive topical therapy, her skin condition did not improve significantly until scabies was detected and treated 1 week after admission. Because of the huge number of mites found and the crusted appearance, a diagnosis of crusted (Norwegian) scabies was made. She was successfully treated with two doses of ivermectin orally and one application of lindane ointment. Permethrin cream was not tolerated. In this patient crusted scabies may have developed because of: (i) a modified host response due to malnourishment; (ii) inability to scratch because of the absence of fingernails; and (iii) abnormal scratching behaviour because of the vulnerability of EB skin, or a combination of these factors. Limited isolation measures were taken on admission and full measures were taken immediately after the diagnosis of crusted scabies was made. Prophylactic treatment of ward personnel was not undertaken. Fortunately, there was not an outbreak of scabies in the hospital.     

挪威疥合并单纯型大疱性表皮松解症及狼疮性肾炎一例

患者,女,39岁。全身红斑结痂伴痒半年,蛋白尿3周。既往背部四肢反复破溃28年。组织病理示：角化过度伴灶性角化不全,角层下见疥虫,棘层肥厚,皮屑镜检见疥虫。电子显微镜示：表皮细胞间细胞连接装置明显减少或缺如,细胞之间可见明显间隙,部分区域大疱形成。血红蛋白74 g/L,尿蛋白+++,ANA阳性,抗心磷脂抗体IgG 31.9 U。诊断：挪威疥;单纯型大疱性表皮松解症;狼疮性肾炎。     

Localised genital Norwegian scabies in an AIDS patient

OBJECTIVES: We present a case of an AIDS patient with Norwegian scabies manifest by a single, crusted plaque localised to the glans penis. METHODS: A 45 year old man with AIDS presented to our clinic complaining of a red papular pruritic rash on his abdomen and anterior thighs and a single, thick, crusted, non-pruritic lesion on the penis. He had been treated with lindane topically prior to the development of the penile lesion without resolution of the pruritus or red papular lesions. A mineral oil preparation was obtained from the hyperkeratotic penile lesion and revealed numerous mite eggs and faeces. RESULTS: The diagnosis of localised, genital Norwegian scabies was made. The patient was treated with ivermectin 200 micro g/kg per dose taken as two doses, 14 days apart, with complete resolution of both pruritus and skin lesions. CONCLUSIONS: This patient is the first known report of Norwegian scabies localised as a single lesion on the penis. He was successfully treated with oral ivermectin monotherapy.     

Norwegian scabies in a girl with psoriasis

A four-year old girl had Norwegian scabies, many of the manifestations of which were initially ascribed to psoriasis which was present then and is still present five years later No predisposing factor was present. From a study of reported cases, Norwegian scabies appears to be very uncommon in children and especially in girls, only one previous report in a girl being found in the literature of the past 35 years.     

Crusted scabies in acquired selective IgA deficiency.

Crusted scabies, an unusual clinical variant of human scabies mite infestation, is usually reported in cases of gross debility, mental deficiency, or immunosuppression. We report here the occurrence of crusted scabies in a 40-year-old man with acquired selective IgA deficiency suspected to be caused by long-term medication with phenytoin for epilepsy.     

Crusted (Norwegian) scabies in a patient with smoldering adult T-cell leukemia

Crusted (Norwegian) scabies is described in a patient with smoldering adult T-cell leukemia (ATL). The patient is an 84-year-old Japanese woman who presented with widespread scaling over the trunk and limbs and crusted lesions on the scalp and ears. Microscopical examination of scrapings from the scalp and ears showed extraordinarily large numbers of scabies mites. The white blood cell count was 5.1 x 10(9)/L with 6% abnormal lymphocytes with mature nuclei that showed convolution and lobulation. Anti-HTLV-I antibodies were positive. Southern blot analysis revealed that the cellular DNA extracted from this patient's peripheral blood cells, digested with Pst I, showed the same pattern of provirus genome as the DNA from ATL patients. A diagnosis of crusted scabies with smoldering ATL was made. It is possible that crusted scabies could be an opportunistic infection and a pre-diagnostic sign of ATL.     

Disseminated histoplasmosis, invasive pulmonary aspergillosis, and other opportunistic infections in a homosexual patient with acquired immune deficiency syndrome

A homosexual man with the acquired immune deficiency syndrome had an unusually wide array of opportunistic infections. Despite antibiotic treatment over a period of two and a half years, the patient died. Perianal herpetic ulcers, oral candidiasis, cytomegalovirus infection, and disseminated infections with both Histoplasma capsulatum and Mycobacterium avium-intracellulare were diagnosed during illness. An autopsy revealed invasive pulmonary aspergillosis and a cerebellar lesion caused by cytomegalovirus. The latter was probably responsible for the patient's gait disturbance.     

Toenail onychomycosis in patients with acquired immune deficiency syndrome: treatment with terbinafine

Skin infections caused by dermatophytes are one of the most frequent dermatological complications in patients with acquired immunodeficiency syndrome (AIDS) resulting from infection with human immunodeficiency virus (HIV). Tinea unguium associated with AIDS is characterized by being clinically more aggressive and therapeutically more difficult to treat than in the general population. Terbinafine is considered to be a first-choice option for the treatment of dermatophyte onychomycosis in immunocompetent individuals. This drug has been used in a series of 21 HIV-positive patients diagnosed with tinea unguium for 1 year in the University Hospital La Paz, Madrid. All patients underwent a subsequent clinical follow-up for 6 months. The results showed a high percentage of clinical and mycological cures, as well as maintenance of the response after follow-up; no drug interactions or significant adverse effects related to the drug under study were recorded.     

Localized crusted scabies in the acquired immunodeficiency syndrome

Crusted scabies (CrS) is an uncommon occurrence among patients with AIDS. Indeed to date only five cases have been described, all with widespread lesions. A case of localized CrS appearing as a yellowish and crusted plaque on the second right toe is reported in a woman with AIDS. Scraping off the verrucous surface, as well as punch-biopsy revealed many mites within the horny layer. The infestation is related to the cutaneous immune response and thus CrS should be considered an opportunistic infestation in AIDS. The importance of the early diagnosis of CrS in order to prevent disseminated lesions and involvement of other health-care workers is underlined.