Aripiprazole Treatment in Delusional Infestation: Resolving Atypical Presentations of Body Fluid Leakage

BACKGROUND Delusional infestation is a rare psychiatric disorder characterized by the fixed belief of being infested with parasites or other unseen organisms. Atypical presentations, such as delusions of infectious body fluid leakage, can pose diagnostic challenges. This report describes 2 cases of women with such atypical delusions, highlighting the importance of recognizing this unusual manifestation of delusional infestation. CASE REPORT Two women, ages 57 and 41 years, presented with persistent skin lesions and intense itching, initially misdiagnosed as dermatological conditions. Detailed psychiatric interviews revealed unusual delusions of infectious body fluid leakage related to their skin. Both patients had consulted multiple specialists and received various treatments without improvement. Following a diagnosis of primary delusional infestation, both were treated with aripiprazole, resulting in significant symptom improvement and resolution of skin lesions. CONCLUSIONS These cases underscore the importance of recognizing atypical presentations of delusional infestation, including delusions of infectious body fluid leakage. The diagnosis relies on the exclusion of secondary causes of delusional infestation, such as other medical, neurological, and psychiatric conditions, along with a multidisciplinary approach among psychiatrists and dermatologists. The role of the histopathology among investigations of delusional infestation is very limited. A high index of suspicion and thorough psychiatric evaluation are crucial in cases of refractory dermatological symptoms, to ensure timely diagnosis and appropriate treatment, preventing prolonged suffering and unnecessary healthcare utilization.