Case History
Last month the Cooperative Extension Service referred
a client from the Midlands to the Agromedicine Program. He complained that his skin was infested
with mites. He discussed his illness several times with Dr. Schuman and Dr.
Simpson during the next several weeks.
The patient reported itching of his scalp, ears, arms
and legs for the past four months. The itching was so severe that he was not
able to sleep at night. The mites had followed him and his family from one
house to another. He had his new home treated several times by a pest control company
without relief. He has now started applying insecticides himself in an effort
to rid the home of mites. Other family members and pets were unaffected by the
mites.
The patient had been examined and treated by his
family physician and a dermatologist. Both doctors treated the patient for
dermatitis of unknown origin; however the itching only increased in severity. The patient lost confidence in both
physicians. He sent numerous skin scraping samples to university entomologists who
did not observe mites or any other insects.
Dr. Schuman thought this might be a case of early delusory
parasitosis. This is a condition in which patients Dr. Stanley Schuman (center)
was awarded the Order of the Palmetto on November 3, 2000 in recognition of his
statewide public service through the Agromedicine Program. Mr. Nick Theodore (right),
senior counsel to Governor Hodges, presented the award to Dr. Schuman at the 50th annual meeting of the S.C. Cattlemen's Association held in Greenville,
S.C. Dr. Victor Cornett (left), president of the association, nominated Dr. Schuman.
Photo by Danny Howard. have a strong false belief that they are infested with parasites.
These patients typically seek treatment from a series of physicians and
entomology specialists. They use
extreme methods (repeated insecticide applications, showering numerous times
daily, moving, etc.) to rid themselves of the insects. Dr. Schuman scheduled
the patient to see a MUSC dermatologist experienced in treating this type of
case with success.
Prior to the appointment, the patient began searching
the Internet and medical databases for cases similar to his. He learned that
delusory parasitosis is treated with the psychotropic medication, pimozide.
After learning this, he telephoned our office to cancel the appointment with
the dermatologist and stated that he did not have a psychosis.
Patients with this disorder usually resist treatment
after learning that pimozide is a psychotropic medication. The medical
literature1 has shown pimozide to be an effective treatment, here
and overseas.
1Goddard J. Physician's guide to
arthropods of medical importance, CRC Press, Boca Raton, FL 1996, p 66.
MUSC DEPARTTMENTT OFF FAMIILLY MEDIICIINE – DIIVIISIION OFF PUBLLIIC HEALLTTH AND PUBLLIIC SERVIICE
19 HAGOOD AVENUE – SUIITTE 305 HOT,, P..O.. BOX 250805,,CHARLLESTTON,, SC 29425