Case Report: Ekbom Syndrome Presented with Shared Psychotic Disorder

Background: Ekbom syndrome, which is also known as delusional parasitosis, is an infrequent psychotic disorder that is marked by a very intense and strongly unshakeable false belief that there is a parasitic infestation, usually occurring on or beneath the skin, even though there is no medical proof to explain it. This phenomenon can also present with a shared psychotic disorder which eventually is very rare, accounting for only 5-15%  of psychiatric cases worldwide.     Case Presentation: Mrs. Z, a 56-year-old woman, consulted the emergency unit of Universitas Sumatera Utara General Hospital along with her daughter, complaining of serious itchiness and skin problem due to crawling bugs and worms beneath her skin. Mrs. Z appeared furious, agitated and hyperventilating. Her daughter also admitted that she has the same skin condition. They have tried to appoint a consultation to several doctors but did not get any “appropriate” explanation. 1 ml of Haloperidol (5mg/ml) was initially administered via IM injection to calm Mrs. Z, and oxygen was given to help ease her breathing. We then advised Mrs.  Z and her daughter to visit our psychiatry outpatient clinic the day afteron the next day. Through a careful interview, we found that Mrs.  Z experienced Ekbom syndrome or delusional parasitosis that is also shared with her daughter. Both were given risperidone with an initial dose of 1 mg/day and sertraline 50mg/day.     Conclusion: We found a rare case of delusional parasitosis presented with shared psychotic disorder among a mother and a daughter. Initiation of psychiatric therapy is quite challenging, as patients often refuse due to stigmatization and their firm belief that instead of psychiatric illness, they actually have a parasitic infection. A multidisciplinary approach and strong patient-therapist relationship are a necessity in treating this type of patient.  

Delusional parasitosis. A multicenter retrospective study in Spanish infectious disease services

INTRODUCTION

Delusional parasitosis or Ekbom syndrome is a condition described mainly in the fields of psychiatry and dermatology, with a complex diagnostic and therapeutic approach. However, it is uncommon to assess patients with this disease in infectious disease units. The objective of this work is to describe the experience of three infectious diseases departments with respect to this entity.

METHODS

A retrospective descriptive study of 20 patients diagnosed with delusional parasitosis in three Infectious Diseases Services was performed between 2003 and 2017.

RESULTS

The median age of the patients was 54 years, with a female/male ratio of 1.5:1. In 9 patients, an endoparasitic delirium (mainly digestive) was described, in 5 an ectoparasitic form was described, and in the remaining 6, a mixed form was described. Fourteen patients presented some type of psychiatric disorder. Four patients had alcohol or drug abuse disorder. All patients had made consultations to other specialties with a median of three per patient (range 1-7). Ten patients received "empirical" antiparasitic treatment and 8 received some type of psychopharmaceutical treatment. The evolution was very variable: in 3 patients, the delusional parasitosis was resolved; in 9 patients, the clinical manifestations persisted, and the remaining patients were lost to follow-up.

CONCLUSIONS

Ekbom syndrome is a common process in infectious diseases, presenting some differences with other series evaluated by dermatologists and psychiatrists. Management of this disease should promote a multidisciplinary approach to enable a joint treatment, thus optimizing patient management and therapeutic adherence.