Sepsis Secondary to Crusted Scabies Following Iatrogenic Treatment for Hansen's Disease in an Indigenous Amazonian Patient: A Case Report.

INTRODUCTION

Sepsis secondary to crusted scabies is a rare but life-threatening complication of Sarcoptes scabiei infestation, particularly in vulnerable and underserved populations. Misdiagnosis with other dermatological conditions may lead to inappropriate treatment and severe outcomes.

CLINICAL FINDINGS: A 50-year-old Indigenous man from the Brazilian Amazon presented with a one-year history of generalized pruritus, diffuse hyperkeratotic and crusted skin lesions, and progressive clinical deterioration.

DIAGNOSIS INTERVENTIONS AND OUTCOMES: The patient was initially misdiagnosed with Hansen's disease and atopic dermatitis and received prolonged corticosteroid therapy, which exacerbated his condition. Skin scraping confirmed crusted scabies, and blood cultures grew Staphylococcus aureus, establishing the diagnosis of sepsis secondary to skin infection. He was treated with oral ivermectin, topical 5% permethrin, and systemic antibiotics, with gradual tapering and discontinuation of corticosteroids. The patient achieved complete clinical recovery.

CONCLUSION TAKE‐HOME MESSAGE: This case highlights the critical importance of early recognition of crusted scabies and the risks associated with misdiagnosis and inappropriate immunosuppressive therapy. Prompt diagnosis and treatment are essential to prevent severe complications such as sepsis, particularly in resource-limited and endemic settings.