P4079 - A Rare Case of Symptomatic Gastrointestinal Delusional Parasitosis

Saigopal R. Gujjula, MD¹, Jagat Ram Kukkar, MD¹, Salman Haider, MD¹, Sweta Lohani, MBBS, MD¹, Manasa Ginjupalli, MBBS, MD², Atiyah Tidd-Johnson, MD¹, Anuj R. Sharma, MBBS¹, Iyad Al-bustami, MD, MPH(c)³, Amr Dokmak, MD¹, Arnold N. Forlemu, MD, MPH⁴, Leonard Berkowitz, MD^1
1Brooklyn Hospital Center, Brooklyn, NY; ²The Brooklyn Hospital Center, New York, NY; ³Brooklyn Hospital Center, Houston, TX; ⁴Brooklyn Hospital Center, Athens, GA

Introduction: Delusional parasitosis is a rare pathology presenting with unrelenting symptoms often confusing the investigator. Patients commonly present with cutaneous manifestation of symptoms, divided into Ekbom syndrome, a rare disorder that primarily manifests with symptoms of parasites exiting or crawling under the skin and Morgellons disease; sensation of fibers and inanimate objects emerging from the skin.

Case Description/Methods: A 30-year-old man with no past medical or surgical history presented to the clinic with intermittent gray colored diarrhea, and a conviction of parasites moving through his liver and passing from his prostate into his urine and anus. He reported no blood or mucus in his stools. He felt strongly that he had acquired parasites while swimming in a lake in Russia, or possibly through sexual intercourse. Prior medications included metronidazole, ornidazole, praziquantel, artesunate, azithromycin, clarithromycin and moxifloxacin; all promoted temporary relief however symptoms recurred shortly afterwards. Patient was born in Russia and migrated to the United States 1 year prior. He denied smoking or alcohol ingestion and endorsed travel to Mexico, India and Turkey within the past 2 years. Blood tests were negative for tissue transglutaminase IgG / IgA antibody and schistosoma IgG antibodies. Stool samples were negative for ova and parasites in four consecutive samples collected in a four month span. Magnetic resonance imaging of the abdomen imaged a normal liver without underlying mass. Colonoscopy was performed showing gastritis with biopsies negative for inflammatory bowel disease, microscopic colitis or presence of eosinophils. Patient denied psychiatrist evaluation but preferred to seek expert parasitologist/tropical medicine care who also deemed psychiatrist evaluation as most appropriate management.

Discussion: Rarity in this case lies in the patient's firm belief of parasites present in the liver with somatic feeling of parasitic movement in the right upper quadrant and prostate. His description of predominant gastrointestinal symptoms provides an alternative symptomatology, further classifying a novel division for delusional parasitosis with primary gastrointestinal symptoms.


Disclosures:


Saigopal R. Gujjula, MD¹, Jagat Ram Kukkar, MD¹, Salman Haider, MD¹, Sweta Lohani, MBBS, MD¹, Manasa Ginjupalli, MBBS, MD², Atiyah Tidd-Johnson, MD¹, Anuj R. Sharma, MBBS¹, Iyad Al-bustami, MD, MPH(c)³, Amr Dokmak, MD¹, Arnold N. Forlemu, MD, MPH⁴, Leonard Berkowitz, MD¹. P4079 - A Rare Case of Symptomatic Gastrointestinal Delusional Parasitosis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.