title: Crusted scabies-associated immune reconstitution inflammatory syndrome.
abstract: BACKGROUND
  Despite the widely accepted association between crusted scabies and human immunodeficiency virus (HIV)-infection, crusted scabies has not been included in the spectrum of infections associated with immune reconstitution inflammatory syndrome in HIV-infected patients initiating antiretroviral therapy.
  
  
  METHODS
  We report a case of a 28-year-old Mexican individual with late HIV-infection, who had no apparent skin lesions but soon after initiation of antiretroviral therapy, he developed an aggressive form of crusted scabies with rapid progression of lesions. Severe infestation by Sarcoptes scabiei was confirmed by microscopic examination of the scale and skin biopsy. Due to the atypical presentation of scabies in a patient responding to antiretroviral therapy, preceded by no apparent skin lesions at initiation of antiretroviral therapy, the episode was interpreted for the first time as "unmasking crusted scabies-associated immune reconstitution inflammatory syndrome".
  
  
  CONCLUSIONS
  This case illustrates that when crusted scabies is observed in HIV-infected patients responding to antiretroviral therapy, it might as well be considered as a possible manifestation of immune reconstitution inflammatory syndrome. Patient context should be considered for adequate diagnosis and treatment of conditions exacerbated by antiretroviral therapy-induced immune reconstitution.
authors.affiliation: Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, C.P. 14080, Delegación Tlalpan, México D.F.
authors.forename: Mónica
authors.initials: M
authors.lastname: Fernández-Sánchez
authors.forename: Marcela
authors.initials: M
authors.lastname: Saeb-Lima
authors.forename: Claudia
authors.initials: C
authors.lastname: Alvarado-de la Barrera
authors.forename: Gustavo
authors.initials: G
authors.lastname: Reyes-Terán
mesh_terms: D000328:Adult; D000818:Animals; D015658:HIV Infections / Q000150:complications; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D012520:Sarcoptes scabiei / Q000472:pathogenicity; D012532:Scabies / Q000150:complications* / Q000175:diagnosis*