Zhang Yan, Ding Xiaojin, Wu Jing, Yu Wenyan, Pan Kenv, Xu Aifang
Department of Clinical Laboratory, Hangzhou Xixi Hospital, Hangzhou Sixth People's Hospital, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
Department of Infectious Diseases Department II, Hangzhou Xixi Hospital, Hangzhou Sixth People's Hospital, Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
Medicine (Baltimore). 2025 Aug 8;104(32):e43792. doi: 10.1097/MD.0000000000043792.
Norwegian scabies (crusted scabies) is an extreme manifestation of Sarcoptes scabiei infestation, primarily affecting immunocompromised populations such as HIV-positive individuals. This condition is characterized by a severe mite burden and high transmissibility, often accompanied by pathognomonic hyperkeratotic plaques.
A 46-year-old male patient diagnosed with HIV presented with persistent fever and progressive cutaneous desquamation, along with lymphadenopathy and worsening rash, initially misdiagnosed as atopic dermatitis.
Microscopic examination of skin scrapings confirmed a diagnosis of Norwegian scabies. Blood cultures and lymph node puncture revealed disseminated Talaromyces marneffei infection. The patient's cluster of differentiation 4 cell count was extremely low, and immunoglobulin E levels were significantly elevated.
The patient received a comprehensive treatment regimen including topical sulfur ointment, oral ivermectin, and voriconazole, in addition to antiretroviral therapy. Supportive care included methylprednisolone and immunoglobulin therapy.
After 1 month of treatment, the patient's skin symptoms completely resolved, and he was discharged.
For immunocompromised HIV patients, routine microscopic examination of skin scrapings is recommended to promptly identify Norwegian scabies, preventing misdiagnosis and potential infectious complications.
挪威疥疮（结痂性疥疮）是疥螨感染的一种极端表现形式，主要影响免疫功能低下人群，如艾滋病毒阳性个体。这种疾病的特征是螨虫负担严重且传染性高，常伴有特征性的角化过度斑块。
一名46岁的男性患者被诊断为艾滋病毒感染者，出现持续发热、进行性皮肤脱屑，伴有淋巴结病和皮疹加重，最初被误诊为特应性皮炎。
皮肤刮片的显微镜检查确诊为挪威疥疮。血培养和淋巴结穿刺显示播散性马尔尼菲篮状菌感染。患者的CD4细胞计数极低，免疫球蛋白E水平显著升高。
除抗逆转录病毒治疗外，患者接受了包括外用硫磺软膏、口服伊维菌素和伏立康唑在内的综合治疗方案。支持性治疗包括甲基强的松龙和免疫球蛋白治疗。
经过1个月的治疗，患者的皮肤症状完全缓解，随后出院。
对于免疫功能低下的艾滋病毒患者，建议常规进行皮肤刮片显微镜检查，以便及时发现挪威疥疮，防止误诊和潜在的感染并发症。
