Disclosures: Kennedy Perry, BA: No financial relationships or conflicts of interest

Case Diagnosis: 60-year-old Caucasian male, post resection of thalamic oligodendroglioma, with delusional parasitosis

Case Description: The patient presented to the Emergency Department for altered mental status and decreasing activities of daily living. He was found to have an acute-on-chronic subdural hematoma and referred to a rehabilitation program. He had a past medical history of thalamic oligodendroglioma that was resected in 2000. He presented with the delusional parasitosis 6 days after entering the rehabilitation unit. He would perseverate on bugs being in his room. He would claim they are mating on him or flying around the room. He would also show pieces of lint to the staff and say that seasonings, like pepper, on his food were the bugs he was seeing. The patient was originally on quetiapine but was changed to olanzapine before going home. The patient has since cancelled the appointment with the rehabilitation group and been lost to follow up.

Setting: Traumatic Brain Injury: In-patient rehabilitation.Assessment/

Results: Due to the disruption of the thalamus, the patient developed delusional parasitosis that was noted during his rehabilitation stay.

Discussion: Diagnosis of delusional parasitosis can be disruptive to home life and people living in the household with these patients. As seen in this patient, the significant other was reluctant to talk about previous episodes. These feelings and thoughts can persist even after reassurance and spraying for bugs.

Conclusion: Delusional parasitosis is commonly idiopathic, but in this case, it was attributed to the disruption of the thalamus. While rare, it can be treated with atypical antipsychotics.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/delusional-parasitosis-due-to-a-brain-tumor-a-case-study/