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Joint Bone Spine
Volume 78, n° 4
pages 402-404 (juillet 2011)
Doi : 10.1016/j.jbspin.2011.02.008
accepted : 7 February 2011
Crusted Norwegian scabies, an opportunistic infection, with tocilizumab in rheumatoid arthritis
 

Khadija Baccouche a, Jérémie Sellam a, Sarah Guegan b, Sélim Aractingi b, Francis Berenbaum a,
a Department of Rheumatology, AP–HP, Saint-Antoine Hospital, Pierre-et-Marie-Curie University, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France 
b Department of Dermatology-Allergology, AP–HP, Tenon Hospital, Pierre-et-Marie-Curie University, 1 rue de la Chine, 75020 Paris, France 

Corresponding author. Tel.: +33 1 49 28 25 20; fax: +33 1 49 28 25 13.
Abstract
Background

Crusted Norwegian scabies is an extremely rare hyperkeratotic variant of scabies infestation. We report herein a case of crusted scabies in a woman with severe rheumatoid arthritis (RA) treated by tocilizumab (TCZ), a monoclonal antibody blocking the interleukin-6 receptor.

Observation

An 80-year-old female with severe RA developed erythroderma followed by hyperkeratosis, widespread scaling over the trunk, arms, hands and limbs, and crusted lesions on her scalp. She was on TCZ (8mg/kg per month) with prednisone (20mg/d). Several hypotheses were evoked (i.e., vasculitis, psoriasis or paraneoplasic syndrome) but a microscopic examination of the skin surprisingly demonstrated numerous scabies mites and eggs leading to the diagnosis of crusted (Norwegian) scabies. After repeated use of ivermectin and application of topical piperonyl butoxide cream, scabies disappeared. However, there had been outbreak of scabies among two individuals in the staff and two patients. TCZ was stopped after four infusions because of a severe infectious pneumonia and failure.

Conclusion

Crusted scabies should be evoked in case of pruritus or erythroderma occurring under TCZ therapy and it may be explained by the interleukin-6 blockade.

The full text of this article is available in PDF format.

Keywords : Rheumatoid arthritis, Crusted scabies, Norwegian scabies, Interleukin-6, Tocilizumab




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