Dermatopathic lymphadenitis from discoid lupus erythematosus and occult scabies in a rural Aboriginal Australian patient: A clinicopathological challenge

This is a case report of an Australian Aboriginal patient from a remote region who had scabies with secondary discoid lupus erythematosus and dermatopathic lymphadenitis. Both the medical and social issues involved are discussed.ABSTRACTScabies and discoid lupus erythematosus are frequent dermopathies diagnosed in Australian Aboriginal and Torres Strait Islanders. Concomitant pathologies can complicate clinical symptoms and histological interpretation. Furthermore, chronic untreated dermopathies may lead to dermatopathic lymphadenitis, a benign lymphadenopathy that can mimic lymphoproliferative disorders.Presented here is a rare and diagnostically complex case involving a 66-year-old Aboriginal female patient from a rural community. She had a two-year history of depigmented plaques, generalised pruritus, unexplained chronically elevated inflammatory markers, and new constitutional symptoms. Initial skin biopsies showed mixed histological findings favouring discoid lupus erythematosus and occult scabies. The patient was treated with topical steroids and ivermectin, which resolved the pruritus and raised inflammatory markers. Further investigation culminated in a final diagnosis of co-existing scabies, discoid lupus erythematosus and dermatopathic lymphadenitis.This case demonstrates the importance of considering and empirically treating scabies in Aboriginal and Torres Strait Islander peoples with unexplained pruritus and eosinophilia, even when classic scabetic signs such as burrows and nodules are absent.