Crusted Scabies Induced Hypereosinophilic Syndrome

Abstract

Crusted scabies causes extensive hyperkeratotic skin lesions, crusting, and scaling and is common in elderly and institutionalized patients. We present a case of crusted scabies in a patient with encephalopathy and diffuse exfoliative erythroderma. After extensive workup, the patient's condition was attributed to hypereosinophilic syndrome due to crusted scabies. Skin condition, mental status, and eosinophilia improved with high-dose steroids in conjunction with topical permethrin and oral ivermectin.

Keywords: crusted scabies; erythroderma; hypereosinophilia; hypereosinophilic syndrome; hyperkeratotic skin lesions.

Figure 1. Erythroderma with hyperkeratotic crusty scaly lesions seen on bilateral lower legs (A), abdomen (B), hand (C) and feet (D).

Figure 2. A. Sections from the punch biopsy of skin show acanthosis, spongiosis, hyperkeratosis with intracorneal microabscesses, increased fibrosis of the reticular dermis, and moderate perivascular and dermal inflammation composed of a mix of lymphocytes, plasma cells, and eosinophils. B. Sarcoptes scabiei mites are present within the subcorneal layer.

Figure 3. Improvement in the rash during follow-up in clinic in one week.