Scabetic leukocytoclastic vasculitis: A case report

A 49-year-old woman presented with a 2-week history of painful necrotic purpura on her legs preceded by a 3-month history of a generalized, intensely pruritic eruption. She had no recent drug intake. Physical examination revealed palpable purpura with bullous and necrotic centers on both legs (Fig. 1). There were multiple erythematous papules, eczematous plaques, and excoriations on her arms, breasts, buttocks, legs and abdomen (Fig. 2). Burrows were found on the interdigital webs of her hands. A scabies mite was isolated from one of the burrows on the hand, by skin scraping. A biopsy specimen of a purpuric lesion was obtained from the leg. Histologic examination showed an inflammatory cell infiltrate, composed of neutrophils, eosinophils and lymphocytes, within and around vessel walls. Epidermic and dermic necrosis, leukocytoclasia and thrombotic vessels were also observed (Fig. 3). Platelet count was normal. Serological and virological tests were negative for (HIV, HBs Ag, anti-HCV, CMV, EBV, parvovirus B19, Chlamydia pneumoniae). Screening for antinuclear antibodies (ANA), anti-neutrophilic cytoplasmic antibodies (ANCA) and cryoglobulin was negative. Electrophoresis of serum proteins and complement fragments was normal. No proteinuria was seen. The patient was treated with topical benzyl benzoate lotion. Complete regression of itchiness and purpuric lesions had occurred within a few days. No additional skin lesions developed. ABSTRACT