Case report: Delusional infestation in dementia with Lewy bodies

Abstract

BackgroundDelusional infestation is characterized by delusions of being infested with parasites, vermin, or small insects and is frequently accompanied by tactile and visual hallucinations. Herein, we report two cases of dementia with Lewy bodies (DLB) with delusional infestation.Case presentationCase 1 was an 83-year-old man. At the age of 75, he began to show symptoms of rapid eye movement sleep behavior disorder. At the age of 83, he began to complain of visual hallucinations of people and delusional infestation with tactile and visual hallucinations of insects, resulting in the use of insecticides for non-existent insects. He also complained of mild amnesia and was admitted to our psychiatric ward for evaluation and treatment. After admission, the delusional infestation disappeared without any new medication. Based on our examinations, he was diagnosed with probable DLB with delusional infestation. He was treated with 5 mg/day of donepezil hydrochloride; his visual and tactile hallucinations disappeared, and the delusional infestation had not recurred at the 1-year follow-up. Case 2 was a 69-year-old woman. At the age of 60, she underwent clipping for subarachnoid hemorrhage (SAH). At the age of 65, she began to have visual hallucinations of people. At the age of 67, she began to complain of visual illusions in which she mistook lint for insects. At the age of 69, she developed delusional infestation and mild amnesia. She took various actions to get rid of these non-existent insects, including insecticide use, consulting an exterminator, and visiting several dermatologists. She eventually burnt her leg in an attempt to kill the non-existent insects. Based on our examinations, she was diagnosed with prodromal DLB in addition to SAH sequelae. We determined that her delusional infestation was caused by DLB rather than SAH sequelae based on the course of her symptoms. She was treated with a combination of 3 mg/day of donepezil hydrochloride and 12.5 mg/day of quetiapine. Thereafter, the delusional infestation partially improved, and she took no further action against non-existent insects.ConclusionDelusional infestation may be caused by DLB. Acetylcholinesterase inhibitors (AChEI) may be effective for delusional infestation in DLB, although antipsychotics may also be needed in severe cases.

A Longitudinal Perspective Case Study of Delusional Parasitosis in a Geriatric Psychiatry Unit

“…The neurologist that examined him suspected a possible neurocognitive decline; however, the patient failed to follow up in a neurocognitive clinic, and no medications were started for memory issues, nor did he get a full workup for it. Existing literature shows that DI is rare, and could present in dementia with Lewy bodies [10,11]. The patient experienced symptoms that had become so severe that he had started neglecting his activities of daily living, similar to that of patients with dementia.…”

Care for Social Isolation and Loneliness in a Case With Late-Onset Delusional Disorder

“…Specifically, the patient temporarily made statements suspicious of a delusional infestation. Moreover, given that there have been cases of DLB with delusional infestation as an early symptom [ 9 ], it encourages careful follow-up.…”

Insights into the Medical Evaluation of Ekbom Syndrome: An Overview

“…Also, physicians must take into consideration that, due to the strong sensitivity of DLB to antipsychotics, adverse symptoms such as acute-onset parkinsonism, drowsiness, and neuroleptic malignant syndrome can appear. Taking this aspect into account, some patients can be treated only with acetylcholinesterase inhibitors because they have shown promising results in managing cognitive and behavioral symptoms, indicating that they may be a useful first-line treatment for psychotic symptoms in patients with DLB and psychotic symptoms [119][120][121].…”