Concurrent Leukemia Cutis and Norwegian Scabies: Case Study
Posted: Tuesday, January 19, 2021
A report published in the Journal of Community Hospital Internal Medicine Perspectives identified a rare case of concurrent Norwegian scabies and leukemia cutis. The patient’s diagnosis and treatment were delayed due to the similarity between the scabies infection and the rash associated with leukemia cutis. To avoid potentially fatal delays in treatment, Sahayini Kumar, MD, PhD, of Greater Baltimore Medical Center, and colleagues recommend that clinicians consider the simultaneous occurrence of scabies and leukemia, especially among immunocompromised patients who present with hyperkeratotic lesions that are unresponsive to treatment.
A 62-year-old man presented to the hospital after a long episode of dizziness. He had a medical history of hypertension, uncontrolled type 2 diabetes mellitus, and eczema. Approximately 1 month prior to presentation, he developed a pruritic rash that progressed to his back, arms, chest, abdomen, and groin.
The presence of an atypical lymphocytic infiltrate was consistent with chronic lymphocytic leukemia and confirmed the diagnosis of leukemia cutis. Following the first dose of chemotherapy, the patient’s skin improved. However, after the second dose, the rash reappeared and did not resolve. The researchers suspected relapse of the leukemia cutis, delaying diagnosis and treatment. Over the next 6 months, the rash progressed into an intensely pruritic hyperkeratotic plaque, with crusting on the palms, finger webs, and shins.
A repeat skin biopsy revealed scabies mites, and the patient was diagnosed with crusted Norwegian scabies. The resolution of the first rash after chemotherapy demonstrated that the patient initially had leukemia cutis. However, the weakened immune system and the leukemic infiltrate on the skin most likely acted as a breeding ground for the scabies mites, which later presented as crusted scabies. The scabies resolved over the next month, once the patient was treated with topical permethrin and oral ivermectin.
Disclosure: The authors reported no conflicts of interest.