RESUMO
Scabies is a neglected tropical disease and represents a considerable global burden. Although consensus diagnostic criteria for scabies have been recently published, diagnosing scabies infestation remains challenging in clinical practice. We investigated the diagnostic utility of complete blood cell count (CBC) and CBC-derived ratios obtained at diagnosis in a set of 167 patients who are Vietnamese with confirmed scabies. These parameters were compared with those of patients with dermatophytosis (N = 800) and urticaria (N = 2023), two diseases frequent in Vietnam, which can present with similar skin manifestations to scabies and tend to pose a diagnostic challenge in vulnerable populations. Our analysis revealed that white blood cell, monocyte, and eosinophil counts were significantly higher among patients with scabies than the other two diseases. Similarly, the monocyte-to-lymphocyte ratio (MLR) and eosinophil-to-lymphocyte ratio (ELR) were significantly higher among patients with scabies. The optimal cut-off values to distinguish scabies from dermatophytosis and urticaria were 0.094 for ELR (sensitivity: 74.85%, specificity: 70.7%) and 0.295 for MLR (sensitivity: 52.69%, specificity: 73.54%). CBC, ELR, and MLR are low-cost and easily calculated parameters that may be helpful for the diagnosis of scabies.
RESUMO
We report a patient displaying several symptoms of myelitis associated with atopic dermatitis. The patient, a 35-year-old female, initially suffered from gait titubation that gradually developed into motor disturbance. She underwent many tests (blood, cerebrospinal fluid, electromyography, and brain, cervical, and lumbar spinal cord and muscle MRIs) at several hospitals, including a university institution, over the course of two years until she finally came to our hospital. However, her disease was never identified by these tests, and she was referred to our hospital to start rehabilitation for her disability which was believed to be caused by disuse syndrome. On first examination, muscle hypertonia of both legs, hypoesthesia of all extremities, difficulty sitting, and a low performance level of ADL were observed. Judging by the factors (e.g. age, neurological symptoms), we considered that the patient was not suffering disuse syndrome, and recommended that she attend another medical college hospital for a thorough investigation. The disease was finally diagnosed as atopic myelitis, as indicated by the test results (e.g. hyperIgEemia). She could sit without a back rest and undertake gait training between parallel bars after steroid pulse therapy at the hospital. While she undertook rehabilitation at our hospital, we applied some approaches to adapt to her fluctuating symptoms (e.g. making short leg braces for both legs, injection of botulinum toxin A (BOTOX<sup>®</sup>) in the leg). We recognized we should gather as much information as possible given the rarity of the disease.