Case Number : Case 1536 - 13 May Posted By: Guest

I see fragments of epidermis with autolysis, haemorrage and presence of some exogenous material filamentous (probably related with the wet tissue that the patient used, was it blue and white?). No clear evidence of lice or tick for me and neither an inflammatory reaction. Is it a psychiatric patient?  

I see fragments of eosinophilic jalinic degenerated tissue, cement-like in fig5/7, and something lucid in fig 8, both reminiscent ( but t's very difficult for me and am not sure ) of attachment mouthpart of a Tick...

Agree with the diagnosis. Delusional parasitosis. Once I had a case like this, the patient brought the material in a box and it was almost only keratinized material and debris crusts.

Yes these are fragments of skin that the patient has vigorously removed under the false impression that they have parasites (delusional parasitosis). The history of bringing in material, often in tissue paper, is also typical. We can see a few blue coloured cotton fibres here.  Management relies on trying to gain a rapport with the patient whilst not being to confrontational. A pathology report indicating that careful examination failed to detect any evidence of parasites may be helpful.