Síndrome de Ekbom o delirio parasitario: a propósito de un caso / Ekbom syndrome or parasitic delirium: a case report

RESUMEN Fundamento: el síndrome de Ekbom o delirio de parasitosis, infrecuente trastorno psiquiátrico, está caracterizado por una única idea delirante hipocondríaca de tener la piel infestada por insectos o parásitos, sin deterioro del resto de las funciones. Objetivo: tratar un caso poco infrecuente y típico, de gran interés para dermatólogos, psiquiatras y médicos generales. Presentación del caso: paciente femenina, blanca, de 51 años de edad, enfermera, con antecedentes de salud mental, quien poco después de divorciarse presentó prurito en piel de muslos, tronco y brazos, considerándose infestada por insectos e intentó extraérselos con una aguja de insulina. Acudió a consulta de Dermatología con una muestra de lo obtenido (signo de la caja de fósforos) al inicio se mostró reticente a acudir al psiquiatra. Al examen dermatológico se constataron lesiones autoinflingidas en piel de muslos, tronco y brazos. Al examen psiquiátrico: parestesias, idea delirante hipocondríaca, labilidad afectiva, disforia, hipobulia, desdoblamiento alucino delirante. Juicio crítico ausente. Funciones de relación alteradas. Llevó tratamiento con tioridazina 50 mg diarios. El caso reúne todas las características clínicas descritas. Se comparó con otros casos publicados y similares manifestaciones, y con otros que difirieron en sexo y edad. Conclusiones: el síndrome de Ekbom es una rara afección psiquiátrica de difícil tratamiento que representa un reto para el paciente y su médico. Por su poca frecuencia e inusuales características, debe ser identificado por médicos de familia y otros especialistas.

ABSTRACT Background: Ekbom syndrome is a rare psychiatric disease characterized by the unwavering conviction of having the skin infested of insects or parasites, without deterioration of the rest of the functions. Objective: to present a typical case of an uncommon disorder, of interest for dermatologists and psychiatrists. Clinical case: 51 years old white, female patient, nurse, with a history of mental health, who shortly after divorcing presented itching of the skin of the thighs, trunk and arms, considering herself infested by insects and tried to extract them with a needle of insulin. She went to the Dermatology consultation with a sample of what was obtained (matchbox sign) at the beginning, she was reluctant to go to the psychiatrist. The dermatological examination revealed self-inflicted skin lesions on the thighs, trunk and arms. On psychiatric examination: paresthesias, hypochondriac delusional idea, affective lability, dysphoria, hypobulia, delusional hallucinatory splitting. Critical judgment absent. Altered relationship functions. She was treated with thioridazine 50 mg daily. The case meets all the clinical characteristics described. It was compared with other published cases and similar manifestations, and with others that differed in sex and age. Conclusions: Ekbom syndrome is a rare psychiatric condition that is difficult to treat and represents a challenge for the patient and his doctor. Due to its infrequency and unusual characteristics, it must be identified by family doctors and other specialists.

Delirio de parasitosis o síndrome de ekbom / Dilusional parasitosis or Ekbom syndrome

El síndrome de Ekbom también llamado delirio de parasitosis es una condición psiquiátrica poco frecuente en el que los pacientes tienen una idea falsa y fija de estar infestados por parásitos o materiales inanimados. Se presenta el caso de un varón de 54 años con cuadro crónico compatible con este síndrome en el que resalta la buena respuesta a antipsicótico típico a un inicio, complicándose el mismo con discinecia tardía por síntomas extrapiramidales, por lo que se realiza el cambio de tratamiento con buena respuesta a la Risperidona.

Ekbom's syndrome also called Delusional Parasitosis is a rare mental disorder in which patients have a false and fixedidea of being infested by parasites or inanimate materials. A case of a 54-year-old man with a chronic condition compatible with this syndrome is reported. Initially, a good response to typical antipsychotic was highlighted, however it got complicated by a tardive dyskinesia due to extrapyramidal symptoms. Consequently, change of treatment with risperidone resulted in good response.

Delusional infestation. ekbom's syndrome in a 53-year old woman. case report

ABSTRACT Introduction: Delusional infestation is a rare psychiatric disorder defined as a condition in which the patient has the unshakable belief and perception of being infested with parasites. Its treatment is difficult, and frequently includes antipsychotic medications (such as olanzapine or aripiprazole). Non-pharmacological treatment, particularly psychotherapy, can be used for less severe cases. Dermatologists and psychiatrists must take a multi-disciplinary approach (preferably in a psycodermatology dedicated clinic) since this type of patients sometimes refuse treatment. Case description: A 53-year-old female businesswoman describes a clinical history of five years of visual hallucinations, depressive symptoms, and generalized pruritus, along with the use of toxic substances to "clean" her skin and cloths. She reports similar symptoms in some relatives but they were not evaluated. Blood tests and analyses of the "specimen" brought by the patient were performed, yielding negative results. The patient had never been assessed by any specialist, and showed disoriented during the consultation. Follow-up was not possible due to the reluctance of the patient to follow the indications and seek psychiatric treatment. Moreover, the patient did not respond to further communication attempts. Discussion: Delusional infestation is an uncommon disease that endangers the patients and the people around them. Its treatment is difficult and long, and not conducting proper follow-up is a great risk. Its prevalence and incidence is variable and generally unknown. It can affect the patient, their next of kin, pets or the environment, and the "pathogen" can be a living organism or an inanimate object. Conclusion: This case is important as it shows the hardships of treatment, adequate follow-up and care, as well as the need to improve how these patients are approached. Additionally, both classical and uncommon signs and symptoms could be observed as the patient stated that her relatives were affected (possible delusional infestation by proxy).

El síndrome de Ekbom: un trastorno entre la dermatología y la psiquiatría / Ekbom syndrome: a condition between dermatology and psychiatry

Introducción: El síndrome de Ekbom o delirio de parasitosis (DP) representa una psicosis monosintomática, poco frecuente, caracterizada por la creencia firme, por parte de quien la padece, de que está infestado, en contra de toda evidencia, por insectos, gusanos o piojos que habitan y dañan su piel. Los pacientes pueden ver seriamente afectado el trabajo diario o la vida social. Objetivos: Estudiar en profundidad a los pacientes con DP y aprender más de ellos. Método: Se aportan cinco casos: tres mujeres y dos hombres. Resultados: La duración media de los síntomas, hasta que llegaron por primera vez a la consulta, fue de 10 meses. Dos pacientes presentaban ideas delirantes de infestación cutánea y oral. Sentían “lagartijas” o pequeños organismos en sus bocas. Todos los pacientes fueron tratados con pimozida, pero solamente dos remitieron completamente. Posteriormente, dos pacientes se trataron con sulpiride y alcanzaron una remisión total. A otro paciente se le administró risperidona y remitió parcialmente. Los pacientes se evaluaron a los tres, seis y doce meses después del tratamiento. Conclusiones: Se resaltan las dificultades en el diagnóstico y en la elección de la terapéutica adecuada por parte del dermatólogo, quien se enfrenta al dilema de manejar un trastorno psiquiátrico en el campo dermatológico. Además, se ha comprobado que actualmente sólo existe un caso publicado en que coexisten ideas delirantes de infestación en piel y cavidad oral...

Introduction: Ekbom syndrome or delusional parasitosis (DP) represents a rare mono-symptomatic psychosis characterized by the delusional belief of the patient against all evidence, that he is infested by insects, worms or lice that damage his skin. Daily work and/or social activities may be seriously compromised. Objectives: To review cases of patients with DP in order to learn from them. Method: Five cases (3 men and 2 women) are reported. Results: Mean duration of symptoms at the time of the first assessement was 10 months. Two of the patients had delusions of oral and skin parasitosis. They felt small lizards and/or small organisms in their mouths. All of them were treated with pimozide, but only one had complete remission. Later, two of them were treated with sulpiride and achieved total remission. Risperidone was given to one patient, resulting in partial remission. All the patients were evaluated at 3, 6 and 12 months post-treatment. Conclusions: These findings highlight the difficulties encountered in diagnosing DP, in the lack of acceptance of the treatment by the patient, and in choosing the right psychotropic medication by the dermatologist who faces the dilemma of managing a psychiatric condition in a dermatological setting. To the best of our knowledge, there is only one previous report of coexisting delusions of oral and skin parasitosis to date...