07 July 2024
: Case report 
Crusted Scabies in a Pediatric Liver Transplant Recipient on Immunosuppression
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction, Rare disease, Clinical situation which can not be reproduced for ethical reasons
Laura Shih Hui Goh
12ABCDEF, Sivaramakrishnan Venkatesh Karthik23ABCDEF, Nur Hafizah Mohamed Nor34ABCDEF, Dale Lincoln Ser Kheng Loh23ABCDEF, Vidyadhar Padmakar Mali 34ABCDEF*
DOI: 10.12659/AJCR.943128
Am J Case Rep 2024; 25:e943128
Table 1. Case reports of post-solid-organ transplant scabies in the pediatric population.
| Age (years)/Sex | Type of scabies | Diagnosis/transplanted organ/immunosuppression | Symptom onset post-transplant/time to diagnosis after symptom onset | Presentation | Diagnosis | Management | Outcome |
|---|---|---|---|---|---|---|---|
| 17/M []3 | Crusted scabies | Alagille syndrome Liver transplant Tacrolimus | 14 years | Nonpruritic, diffuse round, erythematous vesicles over the buttocks and medial thigh. Large bullae were present on both palms | Skin scraping and direct microscopy | One dose ivermectin 200 mcg/kg and topical 5% permethrin (regimen repeated 1 week later). Seven days of cephalexin for superimposed infection | NA |
| 13/M []4 | Crusted scabies | FSGS Kidney transplant Prednisone (5 mg/d); Mycophenolate (250 mg/d) | 5 years; 1 year | Pruritic, crusted, hyperkeratotic squamous plaques located on both inner wrists, the web spaces of both hands, feet, and genitals | Positive contact history. Skin punch biopsy | Topical benzyl Benzolate lotion, discontinued because of intolerable irritation. Topical 5% sulphur in petrolatum, with daily application over entire body for 2 weeks, followed by application only to affected regions. Note: Ivermectin was not available in the region | Relief from pruritis after 2 weeks. Resolution of all skin lesions after 8 weeks |