Vascular purpura in a patient with severe sarcoptic acariasis

Introduction. The common cutaneous manifestations of human sarcoptic acaria sis are erythematous and pruriginous papules. Vascular purpura in patients with scabies has rarely been reported. We report a case of vascular purpura in the presence of a transient elevation of anticardiolipin antibodies. Case report. A 79 year-old woman was treated with prednisone and chlorambuc il for a lymphoma. She was referred to our institution for diffuse sarcopti c acariasis. Clinical examination showed a petechial purpura on her legs. H istology of two biopsies of purpuric papules showed non inflammatory thromb osis of the upper dermis vessels. Investigations revealed a transient eleva tion of anticardiolipin antibodies, moderate hyperhomocysteinaemia and bloo d eosinophilia. Treatment consisted in ivermectin and repeated applications of benzyl benzoate lotion. The purpura healed within one month, without sp ecific treatment. Discussion. Histological findings of sarcoptic acariasis with vascular purp ura correspond to leukocytoclasic vasculitis. Focal glomerulonephritis has been reported. in our case, histopathology showed a non inflammatory thromb osis of the dermal vessels. We hypothesize that the anticardiolipin antibod ies, hyperhomocysteinaemia and blood eosinophilia may have been the cause o f vascular thrombosis.