# The Two-Year Itch: Extreme Body Lice Infestation Complicated by Anemia, Eosinophilia, and Elevated Immunoglobulin E

## TL;DR

A man with a two-year lice infestation showed symptoms like anemia and high IgE levels, which improved after treatment.

## Contribution

This case highlights a possible causal link between chronic lice infestation and specific blood abnormalities.

## Key findings

- Chronic lice infestation was associated with iron deficiency anemia and elevated IgE levels.
- Treatment with permethrin and ivermectin resolved both the infestation and blood abnormalities.
- The case suggests a direct relationship between lice infestation and immune system changes.

## Abstract

Human lice infestation, or pediculosis, remains a significant global public health concern, particularly in vulnerable populations living in overcrowded, poorly hygienic conditions. Lice are known to be vectors for arthropod-borne diseases such as epidemic typhus and trench fever. However, a growing body of evidence suggests their potential role in the pathogenesis of iron deficiency anemia, peripheral eosinophilia, and elevated immunoglobulin E (IgE) levels. We report a case of a middle-aged male with a two-year history of extensive pruritic skin lesions in the setting of a visible lice infestation over his trunk and clothes. Laboratory investigations demonstrated iron deficiency anemia, peripheral eosinophilia, and markedly elevated serum IgE levels. The patient was treated with topical permethrin and oral ivermectin, along with antibiotics for secondary infection. The infested clothing and other belongings were appropriately discarded to prevent reinfestation. The patient’s skin lesions improved, as did his anemia and eosinophilia, suggesting a causal association between the chronic louse infestation and the observed laboratory derangements.