title: A case report of crusted scabies in an adult patient with Down syndrome.
abstract: OBJECTIVE
  Crusted (Norwegian) scabies is a severe manifestation of the contagious skin infection caused by Sarcoptes scabiei. Crusted scabies has been well described in patients with known immunocompromised states. Treatment may be complicated by delayed diagnosis and/or inadequate treatment. This infection may not rank highly on one's differential diagnosis in the absence of an immunocompromised state, highlighting the uniqueness of the case being presented. Several papers describe immunocompromised children with Down syndrome who are infected with crusted scabies. We present a case of infection in an adult with Down syndrome without evidence of an immunocompromised state.
  
  
  METHODS
  Our patient came to us with a 13-month history of progressively worsening symptoms, the last 4-6 weeks of that time period being most dramatic, despite various treatments. We performed tissue biopsy, culture, and laboratory evaluations, which revealed numerous mites and bacterial superinfection.
  
  
  CONCLUSIONS
  Crusted scabies infection may occur in adult age individuals with Down syndrome regardless of immune status, leading us to encourage practitioners to consider this condition when presented with patients of this population. We also highlight the need for further exploration of disease prevalence in this patient population.
authors.affiliation: Baylor Scott & White Health/Texas A&M College of Medicine. nagsuk@medicine.tamhsc.edu.
authors.forename: Phillips
authors.initials: P
authors.lastname: Nagsuk
authors.forename: Rachel
authors.initials: R
authors.lastname: Moore
authors.forename: Lisa
authors.initials: L
authors.lastname: Lopez
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001706:Biopsy; D060085:Coinfection / Q000188:drug therapy / Q000209:etiology; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D004314:Down Syndrome / Q000150:complications*; D004318:Doxycycline / Q000627:therapeutic use; D004485:Eczema / Q000175:diagnosis; D005192:Family Health; D005260:Female; D005533:Foot Dermatoses / Q000150:complications / Q000175:diagnosis; D006229:Hand Dermatoses / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use; D008875:Middle Aged; D026023:Permethrin / Q000627:therapeutic use; D012532:Scabies / Q000150:complications / Q000175:diagnosis*; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000209:etiology; D015163:Superinfection / Q000188:drug therapy / Q000209:etiology; D014005:Tinea / Q000175:diagnosis
chemical_list: D000900:Anti-Bacterial Agents; D026023:Permethrin; D007559:Ivermectin; D004318:Doxycycline