Medicine · 2025
Norwegian scabies coinfected with disseminated Talaromyces marneffei - a dual challenge in HIV immunodeficiency: A case report.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Zhang Yan, Ding Xiaojin, Wu Jing, Yu Wenyan, Pan Kenv, Xu Aifang
Аннотация
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.
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.