Abstract
Background: Scabies is a common parasitic skin infestation in children but is rarely reported during the
neonatal period. Its clinical presentation in neonates may be atypical, potentially delaying diagnosis.
Hematological abnormalities are not generally considered part of the routine diagnostic assessment of
scabies.
Case presentation: A 22-day-old term female neonate was admitted to the Pediatric Emergency
Department because of a widespread skin rash that had been present for approximately one week and
increasing irritability during the previous 24 hours. She was afebrile, breastfeeding normally, and showed
appropriate weight gain. Physical examination revealed widespread erythematous papules, crusted and
eroded lesions, and linear track-like lesions involving the hands and face. A family history of scabies was
subsequently identified. Dermatological assessment supported the clinical diagnosis of scabies, although the
mite was not identified. Because of the extensive and prolonged skin involvement in a neonate, laboratory
investigations were performed and unexpectedly revealed severe thrombocytopenia, with a platelet count of
28,000/mm³, confirmed by the hospital central laboratory. Inflammatory markers and renal and liver function
tests were unremarkable. The infant was hospitalized for treatment of scabies and hematological monitoring.
Following treatment of the infestation, the skin lesions resolved and the platelet count returned to normal.
Discussion: Thrombocytopenia associated with neonatal scabies has been described in a limited number
of previous reports. The recurrence of a potentially severe hematological abnormality in several
independently reported cases is noteworthy, particularly given the rarity of scabies in the neonatal period.
Experimental studies have also demonstrated that Sarcoptes scabiei products can modulate cytokine
production and endothelial adhesion molecule expression, although a direct mechanism linking infestation to
thrombocytopenia has not been established.
Conclusion: Severe thrombocytopenia may represent an uncommon and clinically silent complication
associated with neonatal scabies. Considering neonatal immunological immaturity, the potential severity of
undetected thrombocytopenia, and the simplicity and limited invasiveness of a complete blood count, we
propose that a complete blood count should be routinely performed in neonates diagnosed with scabies,
even in the absence of overt systemic manifestations.