Background: Crusted scabies, also known as Norwegian scabies, is a rare and extremely debilitating form of Sarcoptes scabiei var. hominis infestation that generally occurs in immunosuppressed patients. Herein, we report a "historic" and fatal case.
Patients and methods: A 52-year-old woman was admitted to the emergency department presenting crusted dermatitis together with extreme deterioration of her general condition. Her general practitioner had initiated dermo-corticosteroid therapy for suspected atopic dermatitis two months earlier, and she had been confined to bed for the previous 10 days. Her son presented pruritus that became worse at night. On examination the patient was moaning, dehydrated and confused and her entire skin was hyperkeratotic, with very thick, yellowish, cracked crusts covering 40 % of her body. Tests indicated severe water and electrolytic disorders as well as Staphylococcus aureus bacteremia. A tape test established the diagnosis of crusted scabies. The severity was grade III on the Davis clinical grading scale. The patient showed signs of multi-organ failure and was transferred to intensive care, but she died during the night.
Discussion: This case is remarkable for its historic severity. In France, scabies infestation is a re-emerging disease and has been a public health priority since 2012. The rare hyperkeratotic form is not fully understood and frequently diagnosed late, in some cases with a fatal outcome.
Keywords: Crusted scabies; Gale croûteuse; Gale hyperkératosique; Gale norvégienne; Mite; Norwegian scabies; Sarcoptes scabiei var. hominis; Scabies.
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