S4490 Stringy Deception: Rare Case of Pseudoparasitosis

Introduction: Gastrointestinal (GI) delusional pseudoparasitosis (DP) is a rare disorder involving the false belief of parasitic infection despite lack of evidence. This can lead to repetitive testing, unnecessary consultations and self-directed treatment, which further jeopardizes both physical health and mental well-being. Case Description: A 60-year-old female resident of the southern United States with a history of irritable bowel syndrome (IBS), gastrointestinal reflux disease, tobacco use, and anxiety presented to clinic reporting 5 months of “worms” in her stool. She had multiple pictures in her phone showing long gelatinous “worms.” She denied recent overseas travel, eating undercooked meat, contact with pets, or any history of parasitic infections. She denied medications other than anxiolytics but reported using Mimosa pudica to “detox from parasites,” believing she was infected. Review of her records showed she had a recent negative workup for parasites and had transitioned to this clinic after being dissatisfied by her care. Our workup including stool ova and parasite, GI multiplex assay was negative for parasites and eosinophilia. Per literature, M. pudica causes clumping and string-like appearance of stool. The patient was counseled to discontinue the supplement. Given her distress, she was prescribed an empiric course of albendazole while emphasizing the negative test results. She was referred to psychiatry for antipsychotics. Discussion: Our patient's case represents a unique isolated delusion from supplement use creating physical “evidence.” M. pudica seeds contain mucilaginous polysaccharides that form viscous stringy structures when exposed to moisture which can be mistaken as worms. A report documents 2 cases of folie à deux where friends taking M. pudica together reinforced each other's delusions. It is marketed for “parasite cleansing,” which may predispose anxious individuals to form delusional beliefs. Ineffective communication, insufficient patient education, and the absence of a multidisciplinary approach can lead to patient dissatisfaction and treatment abandonment. Second-generation antipsychotics have shown efficacy of up to 70% in treating this condition, however high relapse rates (30%) emphasize care be taken to maintain patient trust and follow up. While controversial, our approach utilizing empiric antiparasitics while reinforcing negative workup helped maintain the therapeutic alliance with our patient while transitioning to psychiatric care.