Crusted Scabies leading to osteomyelitis and bilateral below-the-knee amputations - a case report

Crusted scabies is a rare, highly contagious dermatologic condition associated with severe mite infestation, primarily affecting immunocompromised or socioeconomically vulnerable individuals. We report the case of a 38-year-old man with type two diabetes, neuropathy, and housing instability who was misdiagnosed with a hyperkeratotic skin disorder and subsequently developed bilateral foot osteomyelitis. Delayed recognition of crusted scabies led to progressive infection and ultimately necessitated bilateral below-the-knee amputations. Diagnosis was confirmed by bedside potassium hydroxide preparation, and appropriate antiparasitic therapy resulted in rapid clinical improvement. This case highlights the importance of early dermatologic consultation, maintaining a broad differential for hyperkeratotic lesions, and employing simple diagnostic tools in vulnerable populations. Prompt recognition and treatment of crusted scabies is essential to prevent severe morbidity.