Mites and HTLV-1 at the Crux of a 10-Year Itch and Plaque-Like Lesions

Immunosuppression that is associated with human T-cell lymphotropic virus 1 (HTLV-1) infection predisposes to hyperinfective strongyloidiasis.1,2 One study suggests that it also predisposes to crusted scabies.3 In a study of Australian aborigines by Mollison and colleagues,4 all 5 cases of crusted scabies were in patients who were seropositive for HTLV-1. In a series by Blas and colleagues3 conducted in Peru, 16 of 23 patients (69.6%) with crusted scabies were HTLV-1–positive. We present a case of crusted scabies that persisted for 10 years before diagnosis. HTLV-1 infection was the underlying disease, although the erroneous application of topical corticosteroids may have contributed to the severity of the lesions. Acute adult T-cell leukemia/lymphoma (ATLL) later developed as a consequence of HTLV-1 seropositivity.