Right frontal meningioma presenting as delusional parasitosis

Correspondence to Dr Kavitha Konnakkaparambil Ramakrishnan; [email protected]

Background

Delusional parasitosis is a somatic type of delusional disorder, usually monosymptomatic, in which patients have an unshakeable belief that their body is infested with animal parasites such as insects and worms, with no demonstrable objective evidence to prove this. The condition is also known by various other names such as delusion of parasitosis, delusional infestation and Ekbom’s syndrome.¹

Central nervous system tumours are relatively common and can be primary or metastatic. They usually present with specific neurological signs due to mass effect by tumours, but a minority of them present with psychiatric symptoms as their first clinical manifestation.² Meningiomas are one of the most common primary central nervous system tumours in adults and constitute approximately one-third of all intracranial neoplasms. They are generally slow growing and have an insidious onset of symptoms. Personality changes, confusion and altered level of consciousness have been associated with anterior (frontal) and parasagittal meningiomas, and often these cases are misdiagnosed as dementia or depression.³ Here, we report the case of a man in his early 60s who presented to the psychiatry outpatient department with delusional parasitosis as the sole manifestation and was diagnosed to have a right frontal meningioma. To our knowledge, a frontal meningioma presenting as delusional parasitosis has hitherto not been reported in the literature.

Case presentation

A man in his early 60s with no history of any mental illness in the past came to the psychiatry outpatient department with reports of irritability, decreased sleep and itching all over the body of 6 months duration. His symptoms were severe enough to cause marked social and occupational dysfunction. He had gone to several hospitals and clinics for his complaints, getting himself admitted several times. He had been prescribed permethrin cream, calamine lotion and antihistamines among other drugs. Since he was not getting any relief, he had become irritated and frustrated. He went on buying different kinds of over-the-counter lotions to overcome the itching. He took bath several times ‘to get rid of insects’. Lack of any perceivable relief made him report that his family was not attentive to his issues.

He was reported to be a sociable and well-adjusted person before the onset of the present illness,...