Co-presentation of Cotard’s Syndrome and Autohemophagia: A Report of a Rare Case

Cotard's syndrome is a rare neuropsychiatric condition characterized by nihilistic delusions in which patients believe they are dead, do not exist, or have lost their internal organs or bodily functions. Autohemophagia, the act of consuming one's own blood, is an exceedingly uncommon behavior often associated with underlying psychiatric pathology, particularly within the spectrum of psychosis or severe personality disturbance. We present the case of a 28-year-old female who presented with profound nihilistic delusions consistent with Cotard's syndrome, alongside repeated acts of deliberate self-injury followed by ingestion of her own blood. She believed she was already dead, lacked internal organs, and that drinking her own blood was the only way to feel corporeal. Her presentation included marked psychomotor retardation, emotional blunting, and fixed delusional beliefs regarding her own nonexistence. Physical examination revealed numerous healing superficial lacerations, and laboratory studies demonstrated mild anemia. Neuroimaging and electroencephalogram (EEG) were unremarkable. After inpatient psychiatric admission, treatment with risperidone and sertraline, alongside supportive psychotherapy, led to partial remission of her symptoms and cessation of autohemophagic behavior. This case highlights the importance of recognizing unusual and severe psychopathological presentations that may involve high-risk behaviors and complex delusional systems. Clinicians should maintain a high index of suspicion for rare comorbid syndromes in psychotic patients presenting with self-injurious behavior, as early identification and multidisciplinary intervention are essential for effective management and prevention of long-term harm.