Right frontal meningioma presenting as delusional parasitosis

Central nervous system tumours can occasionally present with psychiatric symptoms as the only manifestation and can often pose diagnostic challenges. A man in his early 60s presented to the psychiatry outpatient department with delusional parasitosis. His old age and an episode of urinary and faecal incontinence made the clinician consider neuroimaging at the very first visit itself. He was detected to have a right frontal meningioma with features of intracranial hypertension with midline shift, and he underwent emergency surgery. His delusional symptoms completely resolved after surgery and did not recur during the follow-up period of 2.5 years. A right frontal meningioma presenting as delusional parasitosis has probably not been reported in the literature before, and the case is being reported to highlight the rarity of its presentation, the importance of eliciting a detailed clinical history and the need for early neuroimaging in these cases.

A Rare Case of an Elderly Woman with Delusional Parasitosis (Ekbom’s Syndrome)

Introduction: Delusional parasitosis is a form of relatively rare psychiatric disorder in which the sufferer holds firms false believe of their skin being infested by parasite. On 1938 scientist Ekbom published a case report detailing 8 patients suffering from this delusional perception and hence this condition is also known as Ekbom’s syndrome. Case Presentation: We present a 67 years old normotensive non diabetic female patient who was brought to the outpatient Department by her son with complain that, insects are crawling under her skin. She has been suffering from this condition for three years and it was causing tremendous psychosocial and physical adverse consequences. She has never been on treatment by any specialist before but has received treatment from traditional village healers with little improvement. Conclusion: Ekbom’s syndrome is a rare yet important delusional disorder. This is a hard to treat condition that Doctors should be aware of.

The Unseen Reality

It is not uncommon to encounter a patient who is convinced of a somatic cause for their pain. However, in the case of delusional parasitosis, the patient demonstrates an unshakable conviction of some type of infestation. This can lead various form self-mutilation intended to extract the parasite. They will search for evidence in the excrement. They can seem quite convincing. In some instance, this belief can result in very obsessive cleaning rituals, which may include children. Patients are unconvinced by other explanations and resist psychiatric intervention. However, this, oftentimes, is the only hope for effective management. It is important to not discount the patient; the problem is real to them. Attempts should be made, without reinforcing their delusion, to gain their trust so they will agree to appropriate consultations.