Self-Inflicted Head Injury in Behavioral Variant Frontotemporal Dementia with Compulsive Behaviors: A Case Report

Here we present the case of a 56-year-old right-handed White male who developed osteomyelitis and empyema after repetitive compulsive excoriation rituals. His recent history included profound personality changes, apathy, loss of empathy, limited insight, behavioral agitation, and episodic memory loss. In addition to these progressive behavioral deficits, he had significant difficulties with executive functioning, leading to the loss of his job and inability to independently perform instrumental activities of daily living. Brain MRI showed asymmetric enlargement of the right lateral ventricle and mild asymmetric parenchymal volume loss in the right hippocampus. 18 F-FDG PET imaging revealed severe hypometabolism in the right hemisphere. Based on this individual's clinical presentation, reported history, and neuroimaging findings, we concluded that his condition was most consistent with a diagnosis of behavioral variant frontotemporal dementia (bvFTD), rather than another psychiatric diagnosis. This case illustrates the importance of differentiating between bvFTD and other psychiatric disorders, as well as the need for further studies to improve clinicians' ability to do so at earlier stages.