Case Presentation 3

(If you are squeemish, please do not click the pictures below.)

Patient is a 47yo male with no past medical history who presents with one month history of rash. He denies any "hotness of body," nausea, vomiting, or other symptoms. He states the rash started on his hands and feet and have now spread to the rest of his body including his face and scalp. The rash is itching and sometimes painful. He has come in now because his feet have started cracking and weeping. The patient's vital signs are within normal limits and he denies any other systemic complaints. His DTC was negative as was his VDRL. His hemogram was normal. Please see pictures below at your own risk.

Discussion:

This is a case of Norwegin Scabies. When I first saw it, I thought about syphilis, but with the negative VDRL and the lack of other symptoms (such as a preceeding chancre), we took that off the list. This is pretty much the worest case of scabies I've ever seen. He also has a bacterial superinfection on his feet too. We wanted to start him on Ivermectin and dicloxicillin, but unfortunately the pharmacy doesn't carry Ivermectin. In those cases, we write a prescription and the family members have to pick the medication up at an outside pharmacy. To my knowledge, we are still waiting for the Ivermectin...

Another point this brings up is in infection control. There are very few measures taken on the wards to keep patients from infecting each other. The doctors all walk around with individual hand sanitizer, but I'm pretty sure the nurses wash their hands a few times a day (mostly before eating). There are some gloves available, but they are often difficult to find, and each glove used are charged to the patient. So our patient is probably sharing his scabies with the rest of the ward.

It makes me itch just thinking about it.