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Case Report
An 86-year-old female presented to the dermatology clinic with a 3-week history of an itchy rash located on the trunk and arms. Her past medical history included glaucoma, cataracts, and breast cancer treated with radiation therapy. She had no history of sarcoidosis, tuberculosis, granuloma annulare (GA), atopic diathesis, or new medications. Review of systems was negative for recent fevers, chills, or night sweats.
Physical examination revealed pink urticarial-like papules and plaques scattered over the trunk and extremities (Fig. 1). No burrows were identified. The clinical differential diagnosis included arthropod bites, drug eruption, urticaria, and urticarial vasculitis.
Fig. 1.
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Pink urticarial-like papules and plaques scattered over the trunk and extremities.
A punch biopsy was obtained from the left posterior shoulder and showed a sarcoptic mite in association with granulomatous dermatitis (Fig. 2a). A burrow with a Sarcoptes mite was present within the stratum corneum (Fig. 2b), and non-necrotizing granulomas were present within the dermis (Fig. 2c). Granulomas were surrounded with lymphocytes and scattered eosinophils. Stains for infectious organisms (acid fast bacilli and Grocott’s methenamine stain) were negative, and Alcian blue stain did not demonstrate dermal mucin.
Fig. 2.
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a Granulomatous dermal dermatitis with intracorneal scabies mite. ×100. b Scabies mite burrow. ×400. c Non-necrotizing granulomas surrounded by lymphocytes and scattered eosinophils. ×400.
The patient received treatment for scabies with ivermectin and symptomatic...