Interesting Case Scabies

8/2/2019 Interesting Case Scabies

1/28

4/17/12

CASE PRESENTATION

Mark Dale G.Cruz

By:

Cruz, Mark


2/28

4/17/12

GENERAL DATA:

M.A., 13 year old female, single, Roman Catholic,Filipino,from Bian, Laguna, consulted for the firsttime at San Vicente Health Center on September 16,2010.


3/28

4/17/12

CHIEF COMPLAINT:

itchiness


4/28

4/17/12

HISTORY OF PRESENT ILLNESS:

3 month PTC, patient experienced a gradual onset ofitchiness described as severe and worst at time. This

was associated with papular rashes in the axillae,around the waistline, and on the buttocks. No consult

was done. However, medication was applied to theaffected area in the form of Sulfur soap appliedeveryday. There was no relief.


5/28

4/17/12

1 week PTC, symptoms persisted, but this time it wasassociated with a single nodule (0.5 cm in diameter)on the lateral aspect of the right foot which wasintensely itchy. This was also associated with

undocumented fever described as on and off,moderate, with no medications given.

1 day PTC, symptoms persisted, and the nodule had

significantly increased in size (1 cm.). This promptedthe consult.


6/28

4/17/12

PAST MEDICAL HISTORY:

(-) HPN

(-) DM

(-) CANCER(-)ASTHMA


7/284/17/12

FAMILY HISTORY:

(+) HPN- Mother

(+) Asthma-Mother

(+) COPD-Father(-) DM

(-) CA


8/284/17/12

PERSONAL/SOCIAL HISTORY:

Non-smoker

Occasional alcoholic beverage drinker

Allergic to eggs and fishNo known allergies to drugs


9/28

4/17/12

REVIEW OF SYSTEMS:

General: (-)weight loss, (-)fatigue

Skin: (+)pruritus, (+)papules (+)1 cm. nodule on

lateral aspect of right foot

HEENT: (-)headache, (-)dizziness,

(-)nausea, (-)blurring of vision, (-) discharge,

(-)ear pain, (-)tinnitus,(-)epistaxis, (-)hoarseness, (-)dysphagia,

(-)odynophagia


10/28

4/17/12

Neck: (-)pain, (-) stiffness

Respiratory: (-)hemoptysis, (-)dyspnea

Cardiovascular: (-)clubbing, (-)edema,

(-)pallor, (-)palpitations, (-)cyanosis

GIT: (-)abdominal fullness, (-)loss of appetite,


11/28

4/17/12

GUT: (-)frequency, nocturia, dysuria, hematuria,

urgency, flank pain

Endocrine: (-) heat/cold intolerance, polyuria,

polydipsia

Musculoskeletal: (-)claudication, leg cramps,

muscle/joint pains


12/28


13/28

4/17/12

PHYSICAL EXAM:

General: Patient is conscious, coherent, not incardiorespiratory distress

Vital Signs: BP= 100/70 Temp= 36.8

PR= 84 RR= 22

Skin: (+)papuler rashes on axillae, around thewaistline, and the buttocks, red to brown, in wavy lines,scattered (+)1 cm.nodule on lateral aspect of right foot

warm to touch


14/28

4/17/12

HEENT: Scalp without lesions, pink palpebralconjunctivae, anicteric sclerae, ears symmetric, acuitygood to whisphered voice, oral mucosa pink withoutlesions, tongue midline, intact TMJ, trachea midline, no

palpable mass and tenderness, (-) CLADS

HEART: Adynamic precordium, normal rate, regular

rhythm, , apex beat is at the 5th ICS MCL, (-) carotidbruits, (-)thrills, (-)heaves, (-)murmurs

LUNGS: Thorax is symmetric with no deformities,


15/28

4/17/12

ABDOMEN: (+)papules on waistline, flat, (-) scars, soft,normoactive bowel sounds, no tenderness, no signs oforganomegally

EXTREMITIES: (+)papules on buttocks and axillae,(+)1 cm.nodule on lateral aspect of right foot, full equalpulses, (-)edema

DRE: no skin tags, no tenderness, no masses,

(-) fecaloid material on examining finger


16/28

4/17/12

SALIENT FEATURES:

13 y/o

Severe itchiness

Worst at night

fever

Lives near a river

Has history of wading in the river

Lives in a crowded community

Papules on waistline, buttocks, axillae

1 cm.nodule on lateral aspect of R foot


17/28

4/17/12

DIFFERENTIAL DIAGNOSIS:

1. Xeroxis

2. Eczemza

3. Psoriasis4. Erysipelas

5. lymphoma


18/28

4/17/12

Xeroxis

RULE IN:

1. Diffuse pruritus

2. No erythema

RULE OUT:

1. Common in elderly

2. Skin appears dry and maybe cracked


19/28

4/17/12

Eczema

RULE IN:

1. itchiness

RULE OUT:

1. Focal scaling skin

2. Principally affects hands and flexor surfaces such asthe popliteal and antecubital fossa


20/28

4/17/12

Psoriasis

RULE IN:

1. Papules

2. Variably prurutic

3. Fairly common

RULE OUT:

1. Absence of plaque-like lesions

2. Not present in the elbows

3. No fingernails involvement


21/28

4/17/12

Erysipelas

RULE IN:

1. swelling of skin

2. Previous trauma due to scratching

RULE OUT:

1. (-) peau d orange

2. No lymphatic involvement

3. No involvement of bridge of nose and cheeks


22/28

4/17/12

Lymphoma

Rule in

1. Nodular enlargement

2. Due to infection and/or inflammation

Rule out

1. Location-mostly in the neck

2. No constitutional symptoms that suggestmalignancy


23/28

4/17/12

SCABIES

The human itch mite,Sarcoptes scabiei, is a commoncause of itching

dermatosis infesting ~300 million persons

worldwide. Gravid femalemites, measuring ~0.3 mm in length, burrow

superficially beneath the

stratum corneum, depositing three or fewer eggs perday.

Nymphs mature in ~2 weeks and then emerge asadults to the surface of the skin, where they mate and

(re)invade the skin of the same or another host


24/28

4/17/12

Pruritus is the most common symptom. The itchingand rash associated with scabies derive from asensitization reaction directed against the excreta thatthe mite deposits in its burrow.

An initial infestation remains asymptomatic for up to6

weeks, and a reinfestation produces a hypersensitivity

reaction without delay. Burrows become surrounded byinfiltrates of eosinophils,

lymphocytes, and histiocytes, and a generalizedhypersensitivity rash later develops in remote sites.


25/28

4/17/12

Hyperinfestation with

thousands of mites, a condition known as crusted

scabies or Norwegian

scabies, may result from glucocorticoid use,immunodeficiency, and

neurologic and psychiatric illnesses that limit itchingand scratching.

Intense itching worsens at night and after a hotshower. Typical burrows

ma be difficult to find because the are few in


26/28

4/17/12

Burrows appear as dark wavy lines in the

epidermis and measure up to 15 mm. Lesions occurmost frequently

on the volar wrists, between the fingers, on theelbows, and on the penis. Small papules and vesicles,often accompanied by eczematous

plaques, pustules, or nodules, are symmetricallydistributed in these

sites and in skin folds under the breasts and aroundthe navel, axillae,

belt line, buttocks, upper thighs, and scrotum. Except


27/28

4/17/12

Scabies should be considered in patients with pruritusand symmetric

polymorphic skin lesions in characteristic locations,

particularly ifthere is a history of household contact with a case.

Biopsies, scrapings of papulovesicular lesions, andmicroscopic

inspection of clear adhesive tape lifted from lesionsmay also

be diagnostic. In the absence of identifiable mites or

mite products, the


28/28

4/17/12

TREATMENT:

Permethrin 5% applied to all areas of the body fromneck down then wash off after 8-14 hrs.

Alternative: lindane 1% 1 oz.lotion or 30 gm. Cream

applied thinly to all areas of the body from neck downthen thoroughly wash off after 8 hrs.

OR Sulfur 6% precipitated in ointment applied thinlyto areas nightly for 3 nights then wash off after 24 hrs.

Interesting Case Scabies

Documents