Bullous Scabies in an Immunocompromised Host

Area of Science:

• Dermatology
• Infectious Diseases
• Public Health

Background:

• A 40-year-old woman with poorly controlled HIV presented with a chronic, pruritic, bullous rash.
• Her symptoms included night sweats, fever, cough, and weight loss, with a CD4 count of 46 cells/mm³ and high viral load.

Observation:

• The patient's rash, predominantly on hands and feet, featured bullae that ruptured without discharge.
• Initial treatments for herpes virus and superinfected dermatosis were ineffective.
• Skin biopsy revealed scabies mites, with diagnosis delayed by atypical presentation and limited resources.

Findings:

• Scabies diagnosis was challenging due to the absence of typical burrows and presence of bullae.
• Topical permethrin and delayed oral ivermectin treatment led to significant improvement.
• Community-wide scabies treatment was necessary before patient discharge.

Implications:

• This case highlights diagnostic and therapeutic challenges of atypical scabies in under-resourced, immunocompromised populations.
• It underscores the importance of considering scabies in bullous dermatoses, even with atypical features.
• Effective public health strategies are vital for controlling scabies outbreaks in vulnerable communities.