Norwegian scabies in a patient treated with Tripterygium glycoside for rheumatoid arthritis

Abstract

We report an 80-year-old male patient with severe rheumatoid arthritis who was treated with tripterygium glycoside, an immunosuppressive agent made from the extract of a Chinese medicinal herb called Tripterygium wilfordii Hook F. The patient had no apparent skin lesions before the treatment, but he developed aggressive hyperkeratotic lesions with rapid progression after using tripterygium glycoside. He was repeatedly diagnosed with eczema, but treatment failed to achieve efficacy. Interestingly, a microscopic examination of the lesions revealed numerous scabies mites and eggs. Thus, we confirmed the diagnosis of Norwegian scabies infection. Treated with crotamiton 10% cream and 10% sulfur ointment for one month, the patient's clinical symptoms disappeared.

Risankizumab-Aggravated Crusted Scabies in a Patient with Down Syndrome

“…In such infestations, the mites colonize the stratum corneum by the thousands [4,7]. CS preferentially develops in individuals with cellular immunity deficiency (organ transplant recipients, bone marrow recipients, persons with human immunodeficiency virus [HIV], lymphomas, etc…) and debilitated individuals (dementia, Down syndrome, quadriplegic, etc…) [1][2][3][4][5]. Debilitation or the inability to scratch may furthermore lead to an uncontrollable proliferation of the parasites .…”

“…The clinical manifestations of CS are highly polymorphous, with the most common being diffuse, thickened squamous-crusted lesions with palmoplantar hyperkeratosis and nail deformities [ 1 ]. Unlike classic scabies, pruritus is not always a symptom [ 3 , 4 ]. The usual locations are the extremities and scalp, but the disease can spread over the entire skin [ 3 , 4 ].…”

“…Unlike classic scabies, pruritus is not always a symptom [ 3 , 4 ]. The usual locations are the extremities and scalp, but the disease can spread over the entire skin [ 3 , 4 ]. A frequent complication is a bacterial infection of the skin cracks [ 2 , 3 ].…”

“…A frequent complication is a bacterial infection of the skin cracks [ 2 , 3 ]. Psoriasis is a common misdiagnosis, particularly in the absence of itch [ 2 , 4 , 7 ].…”

“…Its rarity and clinical heterogeneity make the diagnosis difficult [ 2 ]. Risk factors for CS are immunocompromised patients in general and/or individuals suffering from neurologically or mentally debilitating diseases [ 1 – 4 ]. Patients with Down syndrome are even at higher risk to develop CS as they present immune alterations altering their anti-infectious defense lines [ 5 ].…”