A Case of Scabies-Induced Glomerulonephritis

Introduction: Scabies is caused by the parasitic mite Sarcoptes scabiei var. hominis. Patients with this disease can present with diffuse skin itching and the excoriations can predispose them to bacterial cellulitis. There have been documented cases of post-streptococcal glomerulonephritis (PSGN), rheumatic fever, and systemic sepsis as a complication. Typically, the treatment of PSGN is supportive, and requires treating the underlying infection. Here, we present a case of scabies causing post-infectious glomerulonephritis (PIGN) requiring dialsyis that recovers with supportive therapy Case Description: 63 y.o.male with a history of scabies and noted to be homeless who presented with fever, nausea, vomiting and an AKI. Initial exam was noted for bilateral crackles, peripheral edema, diffuse erythematous rash and distended abdomen. Infectious work-up included a chest X-ray without infiltrates, CT abdomen and pelvis with a thickened bladder wall and mild diffuse abdominal pelvic ascites, urinalysis with >100 white blood cells and red blood cells per high powered field. Blood and urine cultures were negative. He was treated for a presumed urinary tract infection with ceftriaxone 1 g daily for 7 days and permethrin baths. Baseline creatinine was 0.7-0.9 mg/dL, but was elevated to 4.2 mg/dL on admission. Serum creatinine increased to 7.37 mg/dL and patient became more volume overloaded. Ultimately, patient was started on dialysis. Serologic work-up of kidney injury was positive for ANA at 1:80, C3 <20 mg/dL, C4 of 12 mg/dL. Protein electrophoresis of serum and urine were negative for monoclonal bands. All other antibody tests performed were negative. A kidney biopsy was perfomed exhibiting the classic appearance of PIGN. Patient underwent dialysis, but was eventually weaned off after two weeks. At follow-up two months later, his serum creatinine had mostly recovered to 1.21 mg/dL Discussion: Scabies is a common condition across the globe, affecting 300 million people worldwide, and can be associated with concomitant skin infections. PIGN is a complication of this condition and can be treated with supportive care. Patients on dialysis can have their kidney function improve even with severe acute injury, but do not require additional therapy. It is important to note the possibility of multiple infections in patients with scabies infections and keep the possibility of other complications of those infections in minds as a nephrologist.