Mrs. Hightower is a 79-year-old African-American female, who presents to the office with her husband with a chief complaint of persistent bug bites and edema of the lower extremities. The lesions in question are reported on both arms from the wrist to mid upper arm, and the lower extremities from just proximal to the toes to below the knee. The extremities appear erythematous, swollen, and scaly with multiple vesicles and areas denuded of overlying skin. The patient is insistent that the cause of her discomfort is parasites. She claims to have had this complaint constantly for 6 years, starting just after a quadruple bypass and continuing without interruption till the current visit. She reports a history of kidney failure, fatigue, and fluid retention, but denies any other symptoms.

The patient claims that her house is infested with minuscule mites that bite constantly and leave an itching welt unrelieved by any therapy. The mites appeared shortly after a quadruple bypass performed 6 years ago. Despite Mrs. Hightower having removed all furniture and carpet, and repeated exterminator attempts, the mites persist. Her husband, who brought her in today, confirms the story, and offers a sample of the mites to corroborate her story. The lesions appeared initially on her ankles bilaterally, and have spread to all four extremities. She describes the itching as constant to the point of distraction, frequently causing her to scratch till blood is drawn. The lower extremities, particularly the ankles, are red, swollen and have multiple vesicles filled with a clear fluid. The skin itself appears thickened and leathery to the touch. The edema is non-pitting, and appears more as a response to repetitive itching than an accumulation of fluid as she has maintained.

Previous physicians had prescribed anti-histamines, corticosteroids, and various antibiotics for the condition, without change in her symptoms. She states that the skin reddening and discomfort have recently grown much worse, prompting her to seek different medical attention. The inability to acquire the correct diagnosis or relief of symptoms has left the patient depressed and frustrated to the point of tears multiple times during the interview. A scraping was done for scabies along with an examination of the sample provided by the patient.