Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 26, 2022; 10(9): 2858-2863
Published online Mar 26, 2022. doi: 10.12998/wjcc.v10.i9.2858
Delusional parasitosis as premotor symptom of parkinson’s disease: A case report
Miae Oh, Jong Woo Kim, Sang-Min Lee
Miae Oh, Jong Woo Kim, Sang-Min Lee, Department of Psychiatry, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul 02447, South Korea
Author contributions: Oh M reviewed the literature and contributed to manuscript drafting; Kim JW and Lee SM managed the patient and contributed to design the study and data interpretation; Lee SM were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sang-Min Lee, MD, PhD, Clinical Associate Professor, Department of Psychiatry, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Kyungheedae-ro 23, Dongdaemun-gu, Seoul 02447, South Korea. maumdoctor@gmail.com
Received: September 9, 2021
Peer-review started: September 9, 2021
First decision: December 9, 2021
Revised: December 16, 2021
Accepted: January 22, 2022
Article in press: January 22, 2022
Published online: March 26, 2022
Processing time: 194 Days and 0.6 Hours
Abstract
BACKGROUND

Delusional parasitosis is characterized by a false belief of being infested with parasites, insects, or worms. This illness is observed in patients with Parkinson’s disease and is usually related to dopaminergic treatment. To our knowledge, no cases of delusional parasitosis have been reported as a premotor symptom or non-motor symptom of Parkinson’s disease.

CASE SUMMARY

A 75-year-old woman presented with a complaint of itching that she ascribed to the presence of insects in her skin, and she had erythematous plaques on her trunk, arms, buttocks, and face. These symptoms started two months before the visit to the hospital. She took medication, including antipsychotics, with a diagnosis of delusional parasitosis, and the delusion improved after three months. A year later, antipsychotics were discontinued, and anxiety and depression were controlled with medication. However, she complained of bradykinesia, masked face, hand tremor, and mild rigidity, and we performed fluorinated N-3-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) nortropane positron emission tomography (PET), which showed mildly decreased DAT binding in the right anterior putamen and caudate nucleus. Parkinson’s disease was diagnosed on the basis of PET and clinical symptoms.

CONCLUSION

In conclusion, delusional parasitosis can be considered a non-motor sign of Parkinson’s disease along with depression, anxiety, and constipation.

Keywords: Delusional parasitosis, Psychotic symptom, Parkinson’s disease, Nonmotor symptom, Premotor symptom, Case report

Core Tip: Cases of delusional parasitosis during medication, such as dopamine agonists, in Parkinson’s disease have been reported. However, this case report shows that delusional parasitosis occurred before the diagnosis of Parkinson’s disease. In addition, unlike in other treatments for delusional disorders, the patient’s delusions improved quickly. After delusional parasitosis improved, the motor symptoms of Parkinson’s disease were observed, and Parkinson’s disease was diagnosed. The sudden onset of delusional parasitosis in elderly without a psychiatric history could be associated with the premotor or non-motor symptoms of Parkinson’s disease. Therefore, an evaluation of Parkinson’s disease should be considered for elderly with delusional parasitosis.