Norwegian scabies coinfected with disseminated Talaromyces marneffei - a dual challenge in HIV immunodeficiency: A case report.

RATIONALE

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.

PATIENT CONCERNS

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.

DIAGNOSES

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.

INTERVENTIONS

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.

OUTCOMES

After 1 month of treatment, the patient's skin symptoms completely resolved, and he was discharged.

LESSONS

For immunocompromised HIV patients, routine microscopic examination of skin scrapings is recommended to promptly identify Norwegian scabies, preventing misdiagnosis and potential infectious complications.