Severe Norwegian Scabies Infection in Psoriatic Arthritis Patient with Naïve Hepatitis B and Sepsis: A Case Report

Introduction: Norwegian scabies is an acute form of severe scabies infection seen in immunocompromised patients. Psoriasis arthritis (PsA) is a systemic autoimmune disease involving the synovial tissue and skin. Norwegian scabies with its complication that occurs in PsA patients can be difficult to diagnose and cause mortality if untreated. Case presentation: A 39-year-old woman came to Dr. Soetomo’s hospital with complaints of body aches, peeled white scales all over her body, and immobilization for months. Multiple macular erythemas that were covered by thick scales with indistinct borders and multiple ulcers with slough were found. The patient met CASPAR criteria for diagnosing PSA. Sarcoptes scabiei eggs were found on skin scraping. The patient also had naïve hepatitis B and severe sepsis. Low-dose methylprednisolone was given with ivermectin, antibiotic, tenofovir, and regular wound care. The patient responded satisfactorily to the treatment and clinical findings was getting better. The thick crust disappeared, and the patient was able to mobilize. Conclusion: Diagnosing and treating Norwegian scabies in PsA remains challenging, and poor prognostic often follows. Proper and immediate treatment will give a good outcome.