Case 37-2014

Abstract

Psychiatry): A 35-year-old woman was seen in the emergency department of this hospital because of a pruritic rash.The patient had a history of hepatitis C virus (HCV) infection, acne, depression, and drug dependency. She had been in her usual health until 2 weeks before this presentation, when insomnia developed, which she attributed to her loss of a prescription for zolpidem. During the 10 days before this presentation, she reported seeing white "granular balls," which she thought were mites or larvae, emerging from and crawling on her skin, sheets, and clothing and in her feces, apartment, and car, as well as having an associated pruritic rash. She was seen by her physician, who referred her to a dermatologist for consideration of other possible causes of the persistent rash, such as porphyria cutanea tarda, which is associated with HCV infection.Three days before this presentation, the patient ran out of clonazepam (after an undefined period during which she reportedly took more than the prescribed dose) and had increasing anxiety and insomnia. The same day, she reported seeing "bugs" on her 15-month-old son that were emerging from his scalp and were present on his skin and in his diaper and sputum. The patient scratched her skin and her child's skin to remove the offending agents. The day before this presentation, she called emergency medical services and she and her child were transported by ambulance to the emergency department of another hospital. A diagnosis of possible cheyletiellosis was made. She was advised to use selenium sulfide shampoo and to follow up with her physician; the patient returned home with her child. On the morning of admission, while bathing her child, she noted that his scalp was turning red and he was crying. She came with her son to the emergency department of this hospital.The patient reported the presence of bugs on her skin, which she attempted to point out to examiners. She acknowledged a habit of picking at her skin since adolescence, which she said had a calming effect. Fourteen months earlier, shortly after the birth of her son, worsening acne developed that did not respond to treatment with topical antimicrobial agents and tretinoin. Four months later, a facial abscess due

Delusional Infestation

“…Delusional infestation is a condition where an individual has a firmly fixed false belief that they are infested with an infectious agent. Delusional infestation is preferred to the narrower term of delusional parasitosis as patients may report being affected by a range of nondescript or specific vermin, insects, parasites, fungi, bacteria, or viruses [ 1 – 6 ]. While the delusional symptomatology may include any body system, most frequently patients will report formication or sensations of movement or other phenomena associated with the skin.…”

Reframing delusional infestation: perspectives on unresolved puzzles

“…1) Self-inflicted skin trauma caused by mechanical force or fingernails is thought to target the causative pathogen and relieve skin discomfort. 12 , 33 2) Self-therapy with different chemicals or physical strategies aims to kill or flush away the pathogens from the body. 3 , 34 3) Repetitive and intensive self-cleaning with an obsessive trait, such as frequent changing of clothes and hair washing, reflects excessive fear of contamination.…”