MRSA Femoral Osteomyelitis From Superinfected Scabies Lesions: a Pediatric Case Report

Abstract Scabies is a skin infestation from the Sarcoptes scabiei. It is considered a public health issue causing concern in developing countries and is one of the World Health Organization (WHO) Neglected Tropical Disease. Scabies skin lesions may cause severe itch and can be the portal of entry for opportunistic and pathogenic bacteria which can cause serious systemic infections. We report the case of a 3 year-old-boy with recurrent scabies infection presenting to the Emergency Department because of fever and refusal to walk. At medical examination he looked unwell, right thigh was extremely painful on palpation and blood test showed neutrophilic leucocytosis and significantly increased C reactive protein (CRP) and procalcitonin. Magnetic resonance imaging (MRI) showed an osteomyelitis of metaphysis and distal diaphysis of the right femur with associated subperiosteal purulent collection and concomitant pyomyositis and fasciitis of the distal right thigh. Blood cultures turned positive for Methicillin-Resistant Staphylococcus aureus. He received a long course of intravenous antibiotic therapy and his condition slowly improved. Follow-up femur X-ray showed a mixed pattern of erosion and sclerosis at meta-diaphyseal region and periosteal reaction at diaphyseal region. This case highlights the importance of early scabies diagnosis even in Western countries where poverty and household overcrowding are not matters of concern. Early diagnosis, timely begin of proper treatment and evidence of clinical resolution are important elements to prevent recurrence of infection and serious systemic superinfections even from multi-drug resistant bacteria. Clinical consequences from unrecognized disease or inadequate eradication are preventable.