Morgellons
In my years as a physician, I have seen many interesting and strange conditions. Here is a story of one such patient.
She was a neatly dressed lady in her fifties. She was referred to me by her primary care physician for an Infectious Disease consult. She said she was infested with bugs and that they were crawling under her skin. This caused intense itching. She said she was able to scratch at those areas and was sometimes able to dig out the bugs.
She brought a tissue with her with small dark objects stuck on it which she thought were the dead bugs. I looked carefully, and they looked like tiny flecks of dead skin to me. Over many months, she had seen several doctors including Dermatologists. She had undergone a skin biopsy, but no diagnosis was confirmed. Her primary physician finally sent her to me for an Infectious Disease consultation.
I took a detailed history and examined her carefully. Her skin showed signs of intense scratching, but was otherwise normal. I examined her carefully, specifically looking for possible scabies which causes itching but usually in specific areas of the body. I also looked for ‘cutaneous larva migrans'. This also causes intense itching and is caused by the dog and cat round worm, but she did not have the classical skin presentation associated with it.
I looked at her biopsy reports and these just showed a nonspecific inflammation of the skin, with no parasites seen.
I could repeat her biopsies, but I doubted they would show anything. I thought she had a condition known as “Delusional parasitosis". This is a rare disorder in which affected individuals have the fixed, false belief that they are infected by “bugs" such as parasites, worms, bacteria, mites, or other living organisms. As with all delusions, this belief cannot be corrected by reasoning, persuasion, or logical argument. Many affected individuals are quite functional. For some however, delusions of parasitic infection may interfere with usual activities.
A lay term for this condition is Morgellons disease. The name was coined in 2002 by Mary Leitao, a mother who rejected the medical diagnosis of her son's delusional parasitosis. She derived the name from a letter published in 1690 by Sir Thomas Browne who was a physician. He had described an unexplained rash in children.
Leitao and her "Morgellons Research Foundation" successfully lobbied members of the United States Congress and the Centers for Disease Control (CDC) to investigate the condition in 2006. CDC researchers issued the results of their multi-year study in January 2012, indicating that there were no disease organisms present in people with Morgellons and concluded that the affliction was likely a “delusional condition”.
The Morgellons Research Foundation subsequently shut down. The different causes of delusional parasitosis can however also include certain medical conditions, such as a true parasite infestation, thyroid disease, diabetes mellitus, vitamin deficiencies, syphilis, HIV infection, hematologic disorders, and prescription-drug side effects. These have to be ruled out.
Treatment is challenging. If there is an underlying medical problem, then it needs to be treated. For the others, anti-psychotic medications are the treatment of choice assuming you can make the patient take the medications. I usually would prefer to refer to a Psychiatrist, but here again, convincing the patient is very difficult to say the least.
A case in point, this patient was most unhappy with my assessment. She told me that I did not know what I was talking about. She was very sure she had bugs under her skin. I offered to refer her to another Dermatologist as I did not dare bring up a Psychiatrist at that time. She angrily declined and stormed out of the office and I never saw her again. I hope that she is doing well today.
I continue to see similar cases intermittently. One recent patient had to be admitted after her intense itching cased a bacterial infection of her back. The infection was easy to treat, but the underlying condition is something that I am short on answers on.
Probable case of delusional parasitosis
