Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by Sugahara, H. Articles by Sakamoto, M. Search for Related Content PubMed Citation Articles by Sugahara, H. Articles by Sakamoto, M. General Topics in Psychiatry

Delusional Parasitosis Accompanied by Word Deafness Due to Cerebral Infarction: Folie à Deux

TO THE EDITOR: Previous studies have reported that delusional parasitosis is often associated with an underlying psychiatric^1,2 or physical^3–5 disorder. To our knowledge, delusional parasitosis with aphasia has not been previously reported. This letter describes a senile male patient presenting with delusional tinea infestation with word deafness due to cerebral infarction. We will also discuss how Mr. S. involved his wife in a "folie à deux."

Case Report

Mr. S. is a 78-year-old married Japanese man who was referred to our department by a dermatologist because of a delusional complaint of tinea. Mr. S. had a history of hypertension and had been undergoing treatment for more than 45 years. He had also suffered from tinea pedis since military service in his youth. Mr. S. suffered from cerebral infarction more than 6 years before referral to our department. Subsequent magnetic resonance imaging revealed that the infarction was localized in the right occipitotemporal region. Approximately 14 weeks later, Mr. S. presented with total aphasia because of a second infarction. A computed tomography (CT) scan revealed extensive right occipitotemporal and left parietotemporal damages. His motor aphasia gradually improved, and he could express himself verbally after 4 months of speech and language rehabilitation. However, he could not understand spoken language, although he could understand written language. This condition is known as word deafness.

Three years after these infarctions, he complained of tinea infesting his hands, having spread from his feet. He consulted numerous dermatologists over a 2-year period because of a continuation and escalation of symptoms that ultimately included his entire body. He visited the dermatological department of our university hospital approximately 1 year before our first examination of him. He was diagnosed by a dermatologist as having left thumb tinea and subsequently underwent regular treatment involving administration of a common antitinea drug for a year. As a result of treatment, Mr. S. showed no objective signs of illness but continued to complain of symptoms. He was convinced that tinea had infested his entire body surface thus, he continued to demand still more effective therapy. He could not sleep without waking up at midnight and washing his hands to rid them of worms. He once wore off his left thumb nail because of his concerns about treatment.

At the first examination at our clinic, Mr. S. showed the physique of a warrior and was ceremonious. He had no insight into his illness and did not doubt the presence of tinea in his body. He showed no additional abnormal neuropsychiatric signs other than left homonymous hemianopsia and word deafness. His wife also believed that he had tinea and reported that the contagions likely occurred during hiking trips when Mr. S. had come into contact with soil. Because their delusion was so firmly fixed, we informed them in advance that the medication we prescribed is similar to an antibiotic. The treatment was started at a dose of 1.0 mg pimozide per day, and after 6 months, it was gradually increased to 2.6 mg daily.

Within 2 weeks, his delusional symptoms had decreased by 70% and had almost dissipated entirely within 6 months. During treatment, his wife's shared delusion dissipated sooner than his. She began to question whether the medication was an antibiotic or not. We informed her that the medication was not an antibiotic but an antipsychotic drug. She accepted our explanation without hesitation. Consequently, the shared delusion disappeared.

DISCUSSION

The present case was associated with word deafness due to right occipitotemporal and left parietotemporal cerebral infarction. It has been reported that the predominance of fluent aphasia in older patients is related to the higher proportion of posterior infarcts.⁶ Either aphasia or homonymous hemianopsia reportedly occurred in 39% of patients with a subcortical infarct 1.5 cm or larger in size as revealed by CT.⁷ In the present case, both of the two localized infarctions were larger than 1.5 cm. Since Kraepelin's description of the "paranoia of the deaf" in 1915, the connection between sensory impairment and paranoid states in older patients has repeatedly been confirmed. Parallels may be drawn to delusional syndromes caused or triggered by linguistic isolation.⁸ Trabert⁹ reported one premorbid feature, social isolation, based on the results of a meta analysis of 1,223 cases. In the present case, Mr. S. presented no major problems in socialization in daily life. He spent time with his acquaintances playing stones, a Japanese game called "Go," every 3 days. This suggests that he was not suffering from severe social isolation. However, his linguistic isolation may have caused the delusion of parasitosis.

REFERENCES

1. Morris M, Jolly D: Delusional interpretation in late life. Br J Psychiatry 1987; 151:272
2. Renovize E: Delusional infestation and dementia: a case report. Br J Psychiatry 1986; 150:403–405[Abstract/Free Full Text]
3. Lyell A: Delusion of parasitosis. Br J Dermatol 1983; 108:485–499[CrossRef][Medline]
4. Reilly T, Batchelor D: The presentation and treatment of delusional parasitosis: a dermatological perspective. Int Clin Psychopharmacol 1986; 1:340–353[Medline]
5. Ganner H, Lorenzi E: Der dermatozoenwahn. Psychiatrica Clinica 1975; 8:31–44
6. Ferro JM, Madureira S: Aphasia type, age and cerebral infarct. J Neurology 1997; 244:505–509[CrossRef][Medline]
7. Horowitz DR, Tuhrim S: Stroke mechanisms and clinical presentation in large subcortical infarctions. Neurology 1997; 49:1538–1541
8. Fuchs T: Delusional syndromes in sensory impediment—overview and model presentation. Forschritte der Neurologie 1993; 61:257–266
9. Trabert W:100 years of delusional parasitosis. Meta-analysis of 1,223 case reports. Psychopathology 1995; 28:238–246

This article has been cited by other articles:

				N. A. Qureshi, T. A. Al-Habeeb, and Y. S. Al-Ghamdy Making Psychiatric Sense of Sand: A Case of Delusional Disorder in Saudi Arabia Transcultural Psychiatry, June 1, 2004; 41(2): 271 - 280. [Abstract] [PDF]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by Sugahara, H. Articles by Sakamoto, M. Search for Related Content PubMed Citation Articles by Sugahara, H. Articles by Sakamoto, M. General Topics in Psychiatry

Get information about faster international access.

Privacy Policy

Copyright © 2000 Academy of Psychosomatic Medicine. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us