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\begin{document}

\title{A case of crusted scabies in an immunocompetent infant.}



\author[1]{Salima Mami}%
\author[2]{Takwa Bacha}%
\author[1]{Soumaya Gara}%
\author[2]{Noureddine Litaiem}%
\author[1]{meriem jones}%
\author[1]{Faten Zeglaoui}%
\affil[1]{Charles Nicolle Hospital}%
\affil[2]{University of Tunis El Manar Faculty of Medicine of Tunis}%


\vspace{-1em}



  
  \date{June 14, 2024}


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\selectlanguage{english}
\begin{abstract}
This clinical image presents a rare variant of scabies occurring in an
infant with specific clinical presentation that can mislead diagnosis.
Clinicians should be aware of such infection to avoid complications.%
\end{abstract}%



\sloppy


\textbf{Title: A case of crusted scabies in an immunocompetent infant}

\textbf{Authors:} Salima Mami\textsuperscript{1}, Takwa
Bacha\textsuperscript{1}, Soumaya Gara\textsuperscript{1}, Noureddine
Litaiem\textsuperscript{1}, Meriem Jones\textsuperscript{1}, Faten
Zeglaoui\textsuperscript{1}

\textbf{Affiliations~: 1~:} Dermatology department, Charles Nicolle
Hospital, Tunis, Tunisia

\textbf{Corresponding author:} Salima Mami\textsuperscript{1}

Dermatology department, Charles Nicolle Hospital, Tunis, Tunisia

\emph{Msalima1009@gmail.com}

+21654277577

\textbf{Conflicts of interest:} None

\textbf{Consent:} Written informed consent was obtained from the patient
to publish this report in accordance with the journal's patient consent
policy



\textbf{Cover letter}

April 27th,2022

Dear Editor:

We are pleased to submit an original paper entitled ``A case of crusted
scabies in a immunocompetent infant'' for consideration for publication
in clinical case report journal as a clinical image.

In this manuscript, we describe an original case of infantile norwegian
scabies which was initially misdiagnosed and wrongly treated with
corticosteroids resulting in worsening of the symptomatology. We believe
that awareness of this condition with specific clinical presentation is
fundamental to ensure accurate diagnosis and treatment and prevent its
complications . This manuscript has not been published and is not under
consideration for publication elsewhere. We have no conflicts of
interest to disclose. We certify that all authors meet the criteria for
authorship and that they will sign a declaration attesting to
authorship, revealing any potential conflicts of interest, and releasing
copyright if the manuscript is accepted for publication.

Thank you for your consideration.

Sincerely,

Salima Mami, M.D Department of Dermatology Charles Nicolle Hospital,
Tunis, Tunisia.

\textbf{Case presentation:}

A ten-month-old infant, presented with a 4-month history of generalized
itching rush causing sleep disturbance. He received several topical
treatments including corticosteroids. He was also put on oral
corticosteroid which resulted in worsening of his symptoms. Physical
examination showed widespread erythematosus papulopustular lesions
(Figure 1) , scratch marks and thick crusted hyperkeratosis on the palms
and soles (Figure 2). Interrogation revealed familial pruritis. The
diagnosis of Norwegian scabies was made by examining skin scrapings from
the crusted lesions that revealed extensive infestation
with~\emph{Sarcoptes scabiei} . The patient was successfully treated
with benzyl benzoate lotion on D1, D2 and D7 repeated after 2 weeks
associated with salicylic Vaseline 20\% on the palms and soles.

\textbf{Discussion:}

Norwegian scabies is a highly contagious and rare infection, caused by
intense infestation of the skin with countless mites. It occurs
especially in immunocompromised patients or with cognitive
deficiency\textsuperscript{1}. In our case, topical and oral
corticosteroids seem to have a role in the appearance of this form. Its
atypical presentation often leads to misdiagnosis since it mimics
psoriasis, eczema, contact dermatitis, insect bites, systemic infection
and palmoplantar keratoderma\textsuperscript{2}. Physicians should be
aware of this clinical form in order to avoid complications.

\selectlanguage{ngerman}\textbf{Références:}

1- Castro HM, Lisa Eliceche M. Sarna Norueg {[}Norwegian
Scabies{]}.~\emph{Rev Fac Cien Med Univ Nac Cordoba} . 2018;75(1):50-51.
Published 2018 Mar 29. doi:10.31053/1853.0605.v75.n1.16509

2- Siegfried EC, Hebert AA. Diagnosis of Atopic Dermatitis: Mimics,
Overlaps, and Complications.~\emph{J Clin Med} . 2015;4(5):884-917.
Published 2015 May 6. doi:10.3390/jcm4050884

\textbf{Figures~:}

\textbf{Figure 1~:} Papulopustular generalized eruption ((A): trunk, (B)
pustules on the axilla )

\textbf{Figure 2:} Crusted hyperkeratosis ((A): thick on the soles, (B):
palms)\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1/Figure-1}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-2/Figure-2}

\end{center}
\end{figure}

\selectlanguage{english}
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