New Morgellons Case-Report Leaves More Questions Than Answers

New Morgellons case-report. In this report a 45-year-old man presented to the emergency room after overdosing on Benadryl. The man was complaining about burning, and little barbs that appeared in his skin as worms or cocoons which he could express (expel). The physician thought the man may have Morgellons and referred him to psychiatry.

Psychiatry reported the man was not suicidal and the following week the man met with Dermatology who performed a skin biopsy and PCR analysis for Lyme disease. With no significant findings the man was placed on 1mg Risperidone from which he began feeling better. The man requested a family meeting to discuss diagnosis and treatment at home, then was discharged from the hospital.

Follow up for one year was not noted, potentially because the man sought help from Psychiatry outside of the hospital system to which he was admitted after overdosing.

Several concerns I had about this paper are:

  • Fiber analysis was not performed
  • Syphilis was not considered in the differential, and neither was TBRF
  • The patient seems to have been introduced to the term Morgellons through the attending physician and not social media
  • How the attending physician thought of Morgellons is not explained
  • The CDC study is referenced despite its’ demonstrated flaws like of the 115 patients cited only 12 had fiber specimens collected
  • Histological examinations of those 12 patients were insignificant though 43% of samples were considered to include “superficial skin” and not solely cotton cellulose though the study authors concede they likely introduced contaminants during the specimen collection process while this paper states that all specimens were cotton
  • All 12 patients in the CDC study had a positive or equivocal Lyme ELISA while none had a positive WB though none were tested for TBRF or syphilis.

It seems clear the physicians the man saw as detailed in this case-study are not familiar with a majority of the research available about Morgellons disease, and the authors of this report chose to include only one research paper about the infectious nature of Morgellons before forming their conclusions. Because this man did not follow up with a hospital psychiatrist, it is impossible to tell if his condition was remediated or if he continued suffering further debilitation after a series of unreliable interpretations based on limited knowledge.

Morgellons patients are often tested for Lyme Disease, however infectious cases of syphilis and TBRF are significantly far less ruled out whenever this strange skin condition presents.

The first step needs to determine whether delusion exists or not. A delusion is defined as a firmly, but false belief held with strong conviction and contrary to the superior evidence. It is distinct from beliefs based on an unusual perception, such as formication. The beliefs that patients hold could be delusion, true observations, or overvalued ideas. This must be determined on a case-by-case basis. The presentation of a specimen is not a delusional behavior. Patients with DI/MD with animate or inanimate objects can exist, but the belief of cutaneous fibers may or may not be delusional. A physician is required to perform fiber analysis to identify the nature of fibers. If fibers are present and biofilaments of human origin, then they are a true observation. It is also possible that patients might observe fibers and mistake them for worms in which case the idea of infestation could be an overvalued idea. Real infestation with arthropods such as mites can also occur. Additionally, some patients could have lesions with adhering textile fibers that are accidental contaminants and could mistakenly believe that they have MD, in which case they do not have a delusional belief, but a mistaken belief. In summary, if a physician cannot differentiate between true observations, delusions, and overvalued ideas, they should not immediately make a diagnosis of delusional mental illness.

The next procedure would be screening the causes of the symptoms. If a delusional belief is present, then various medical conditions need to be ruled out, including psychiatric disorders (eg, schizophrenia and depression), neurological illnesses (eg, dementia), metabolic illnesses (eg, diabetes), vitamin deficiencies, substance intoxication, tumor, dermatological illnesses (eg, pruritus senilis), and infection. History taking, physical examination, laboratory tests, and even skin biopsy should be carried out. The diagnosis of DI could be classified as primary and secondary. If there are cutaneous fibers present and the belief is not delusional, the underlying cause of the symptoms, such as potential infection, should be examined. A diagnosis of MD is more convincing when spirochetal infection is identified. If a patient has delusional beliefs and has cutaneous fibers, then testing of an underlying infection that can result in neuropathy is needed.

Reframing delusional infestation: perspectives on unresolved puzzles | PRBM (dovepress.com)
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