Scabies simulating Darier disease in an immunosuppressed host

Area of Science:

• Dermatology
• Immunology
• Transplantation

Background:

• Renal transplant recipients often require immunosuppressive therapy.
• Azathioprine and prednisone are common maintenance immunosuppressants.
• Immunosuppression can alter the host's response to infections.

Observation:

• A patient presented with a florid, scaling, papular eruption.
• The rash was clinically indistinguishable from Darier disease.
• Skin biopsy and scrapings revealed scabies infestation.

Findings:

• The patient's presentation was atypical for scabies.
• The eruption exhibited features suggestive of Norwegian scabies.
• A muted inflammatory response due to immunosuppression is hypothesized.

Implications:

• Immunosuppression can lead to atypical presentations of common infestations.
• This case highlights the importance of considering scabies in transplant patients with unusual dermatoses.
• Understanding altered immune responses is crucial in managing infections in immunocompromised individuals.