Wang Mengyan, Wan Hu
Department II of Infectious Diseases, Xixi Hospital of Hangzhou, Hangzhou Xixi Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, 310023, China.
BMC Infect Dis. 2025 Jul 29;25(1):955. doi: 10.1186/s12879-025-11390-8.
Crusted scabies (Norwegian scabies), a rare variant of scabies infestation, typically manifests in immunocompromised hosts or institutionalized patients with characteristic hyperkeratosis and fissured plaques. In AIDS patients with concurrent opportunistic infections like talaromycosis, scabies diagnosis may be obscured by overlapping cutaneous manifestations, potentially delaying appropriate management. This case highlights the diagnostic challenges in differentiating crusted scabies from treatment-refractory dermatitis in advanced HIV patients.
A 46-year-old male with advanced AIDS (the absolute CD4 + count is 3 cells/ul) presented to the emergency department with persistent fever and progressive hyperkeratotic lesions. Two months prior, the patient had been misdiagnosed with atopic dermatitis and treated with dupilumab therapy. Subsequently, talaromycosis-associated febrile symptoms and lymphadenopathy had resolved following liposomal amphotericin B and antiretroviral therapy. Dermatological manifestations, however, remained refractory. Upon readmission, physical examination demonstrated coalescing gray-brown hyperkeratotic plaques with fissures and erythematous denuded areas distributed on the trunk, extremities, and thighs. Histopathologic analysis of biopsy identified Sarcoptes scabiei mites embedded in the stratum corneum, with microscopy of skin scrapings confirming motile mites. Treatment included topical sulfur ointment and oral ivermectin. Gradual resolution of crusts occurred over 4 weeks.
This case underscores the imperative for comprehensive dermatological evaluation in immunocompromised hosts with atypical cutaneous presentations.
结痂性疥疮（挪威疥疮）是疥疮感染的一种罕见变体，通常在免疫功能低下的宿主或患有特征性角化过度和裂隙性斑块的机构化患者中表现出来。在患有如足分支霉病等并发机会性感染的艾滋病患者中，疥疮的诊断可能会因重叠的皮肤表现而变得模糊，从而可能延迟适当的治疗。本病例突出了在晚期艾滋病患者中区分结痂性疥疮与治疗难治性皮炎的诊断挑战。
一名46岁的晚期艾滋病男性患者（绝对CD4+细胞计数为3个/微升）因持续发热和进行性角化过度病变就诊于急诊科。两个月前，该患者被误诊为特应性皮炎并接受了度普利尤单抗治疗。随后，在接受脂质体两性霉素B和抗逆转录病毒治疗后，与足分支霉病相关的发热症状和淋巴结病得到缓解。然而，皮肤表现仍然难治。再次入院时，体格检查发现躯干、四肢和大腿上有融合的灰棕色角化过度斑块，伴有裂隙和红斑性剥脱区。活检的组织病理学分析发现角质层中有疥螨，皮肤刮片显微镜检查证实有活动的螨虫。治疗包括外用硫磺软膏和口服伊维菌素。结痂在4周内逐渐消退。
本病例强调了对具有非典型皮肤表现的免疫功能低下宿主进行全面皮肤科评估的必要性。
