Disseminated Crusted Scabies Following Rituximab Therapy in a Patient With Systemic Sclerosis–Lupus Overlap Syndrome
-
November 3, 2026
Objective:
To report crusted scabies in an immunosuppressed adolescent with systemic sclerosis–systemic lupus erythematosus overlap syndrome after rituximab therapy.
Approach:
- Presentation: A 17-year-old girl presented with four months of progressive skin scaliness, generalized pruritus, and recurrent finger gangrene after receiving rituximab, methotrexate, and high-dose prednisolone for one month.
- Diagnosis: Examination showed widespread thick, yellowish-brown hyperkeratotic crusts. Skin scraping identified Sarcoptes scabiei mites and ova, confirming crusted scabies.
- Treatment: She received oral ivermectin on days 1, 2, 8, 9, 15, 22, and 29; topical permethrin; intravenous antibiotics for a bacterial finger infection; and empirical intravenous immunoglobulin. Family members received single-dose ivermectin.
Key Findings:
- The patient had generalized crusted scabies and infected digital gangrene.
- Marked clinical improvement was documented five months after treatment.
- Family members had similar but less severe symptoms without dissemination.
Interpretation:
The authors state that rituximab-associated B-cell depletion likely compromised mite clearance and allowed hyperinfestation. They note that crusted scabies warrants consideration in immunosuppressed patients with refractory dermatitis, including those without classic burrows.
Limitations:
- This is a single-patient case report.
- Serum IgG was not measured before intravenous immunoglobulin was administered.
Based on findings from:
Disseminated Crusted Scabies After Rituximab in a Patient With Systemic Sclerosis-Lupus Overlap
Annals Of Internal Medicine: Clinical Cases, 2026.
https://www.acpjournals.org/doi/10.7326/aimcc.2026.0156
This content is an AI-generated, fully rewritten summary based on a published scholarly article. It does not reproduce the original text and is not a substitute for the original publication. Readers are encouraged to consult the source for full context, data, and methodology.
