Introduction
Ekbom syndrome is a delusion of infestation characterized by a fixed
false belief that a person is infected with living or non-living
organisms, which persists for at least one month(1). For the diagnosis,
the patient must believe that they are infected with insects despite
evidence to the contrary, and there are aberrant cutaneous sensations
attributable to these beliefs(2).
Patients usually decline psychiatric treatment and are treated mainly by
non-psychiatric experts, particularly dermatologists, for several years
before psychiatric evaluation(3). Females are more affected than
males(4) and the peak age of onset ranges from 55 to 68 years. However,
it can also develop among teens, and recreational substance use has been
linked with the etiology of symptoms among individuals between the ages
of 20 and 40(5).
The patients usually experience body itching accompanied by compulsive
scratching with nails, needles, and razors and also complain of insects
crawling on their skin, where patients may even carry containers to the
doctors to prove their conviction(6). The use of both conventional and
atypical antipsychotics is effective in treating a delusional of
infestation, and depot antipsychotics also result in considerable
symptom remissions in case of poor adherence(7).
This is a case of a 70-year-old female with a 17-year history of living
with HIV and hypertension for 25 years. A dermatologist referred her
with a five-year history of progressive disturbance in functioning due
to perceptions of generalized body itching attributed to a firm belief
of being infested with insects that lead to intense compulsive body
scratching behavior. A low dose of haloperidol was effective in
alleviating psychotic symptoms; however, she developed severe depressive
symptoms a few weeks later, which also resolved after several months of
treatment.