Morgellons disease, illuminating an undefined illness: a case series

Abstract

IntroductionThis review of 25 consecutive patients with Morgellons disease (MD) was undertaken for two primary and extremely fundamental reasons. For semantic accuracy, there is only one "proven" MD patient: the child first given that label. The remainder of inclusive individuals adopted the label based on related descriptions from 1544 through 1884, an internet description quoted from Sir Thomas Browne (1674), or was given the label by practitioners using similar sources. Until now, there has been no formal characterization of MD from detailed examination of all body systems. Our second purpose was to differentiate MD from Delusions of Parasitosis (DP), another "informal" label that fit most of our MD patients. How we defined and how we treated these patients depended literally on factual data that would determine outcome. How they were labeled in one sense was irrelevant, except for the confusing conflict rampant in the medical community, possibly significantly skewing treatment outcomes.Case presentationClinical information was collected from 25 of 30 consecutive self-defined patients with Morgellons disease consisting of laboratory data, medical history and physical examination findings. Abnormalities were quantified and grouped by system, then compared and summarized, but the numbers were too small for more complex mathematical analysis. The quantification of physical and laboratory abnormalities allowed at least the creation of a practical clinical boundary, separating probable Morgellons from non-Morgellons patients. All the 25 patients studied meet the most commonly used DP definitions.ConclusionsThese data suggest Morgellons disease can be characterized as a physical human illness with an often-related delusional component in adults. All medical histories support that behavioral aberrancies onset only after physical symptoms. The identified abnormalities include both immune deficiency and chronic inflammatory markers that correlate strongly with immune cytokine excess. The review of 251 current NLM DP references leads us to the possibility that Morgellons disease and DP are grossly truncated labels of the same illness but with the reversal of the cause-effect order. Further, the patients' data suggest that both illnesses have an infectious origin.

Filament formation associated with spirochetal infection: a comparative approach to Morgellons disease

“…Fibers may be present under unbroken skin as well as in lesions and scabs 20,25. Microangiomas found upon examination are reported 24. Healed lesions demonstrate hyperpigmented scar tissue 25.…”

“…Many patients with Morgellons disease report inability or impaired ability to work. Most patients have been diagnosed with psychiatric or psychosomatic illness, and report that physicians are dismissive and attribute lesions to delusional parasitosis and self-mutilation 20,24,48. While some patients with Morgellons disease do demonstrate behavioral aberrancies including a delusional component, many do not, and psychiatric manifestations are possibly from an underlying pathogenic process 22.…”

“…This implies that the disease may be infectious in nature and transmitted from person to person or transmitted from an inciting agent during familial environmental exposure. Contact with soil or unsanitary environmental conditions appears to be a contributing factor 20,24. Onset has been associated with rural residence or recent rural travel 24.…”

“…Patients with the affliction may experience crawling and stinging sensations from under their skin 19–21. Immune deficiency and the presence of inflammatory markers indicating cytokine release suggest that an infectious process is involved,24 and Morgellons disease has been associated with spirochetal infection 25. These patients often have positive B. burgdorferi Western blots or Lyme-like symptoms, suggesting a high likelihood of Lyme borreliosis 20,25…”

Psychosomatic factors in pruritus

“…The current consensus is that this disease is a new manifestation and variant of delusional infestation with ‘infection’ by an inanimate material. 94,95 …”