Tuesday, March 9, 2010

Delusional Parasitosis

A 38 year old very nervous female arrived to the ED with a large bandage covering her left check. Prior to evaluating the patient, I reviewed her chart and saw that she had a pathology report from a recent biopsy that said "normal tissue consistent with excoriation, no malignant cells identified."

With that information, I went to see the patient. She was very anxious and scratching her whole body. I immediately thought scabies or drug addictions that can make people scratch.

I asked her, "How can I help you today?"

She immediately started telling me the story..."I've got little worms all over my skin and I'm really scared b/c the wound on my cheek keeps getting bigger, and I've already seen the doctor and no one can help me! The worms keep jumping out!"

I asked her, "Do you have an psych conditions, or do you do any drugs?" She denied both.

I then took off the bandage. I was absolutely stunned b/c her entire left cheek was missing until the inside of her mouth. The only tissue left was the very inside of her cheek!

She said, "Can you get the worms out?"

I told her that we could help and then called our Face Surgeon who came to evaluate her. He said that she need immediate psych help (duh), and that once she was mentally stable she would require plastic surgery to repair the large defect. I sent her to psych and hope that she will get better soon!

-Doc Sensitive


Dana said...

This is why you're supposed to consult for a nurse office visit before attempting imagined worm removal!

oddharmonic said...

I hope she feels better too.

When I needed to restart anti-depressants after several years without, I had a nasty flare of psoriasis on my arm. When I finally went to the doctor, I had my elbow wrapped in an elastic bandage to keep from scratching and my husband said it looked like a belt sander had taken a 4x6" patch off the top layer of skin. Resuming SSRIs and two weeks of topical hydrocortisone cleared it right up.

Rosa said...

That poor woman.

StorytellERdoc said...

That's sad...it's painful to watch someone scratch and scratch and scratch at something we can not see. Love Aveeno oatmeal baths, besides other treatments.

Christine said...

Oh boy... I work in the clinical microbiology lab at a university hospital. The crazy specimens we get from people with delusional parasitosis! The last one was an earthworm from someone's yard - the person was convinced that it proved that s/he was also infected with worms.

Anonymous said...

The medical school I went to had a doubly board certified dermatologist/psychiatrist who would see cases like this. More common than most people think....