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.