# Bugs Bugging the Body and the Brain: A Case of a Bed Bug Infestation Progressing to Delusions of Parasitosis Treated With Clozapine

## TL;DR

A man with a mental health condition developed a delusion of bug infestation after a real bed bug problem, and was successfully treated with clozapine.

## Contribution

This case highlights the rare use of clozapine in treating delusional parasitosis.

## Key findings

- The patient's delusional parasitosis followed a real bed bug infestation.
- Clozapine, not typically used for this condition, was effective in treating the delusion.
- Medication adherence and psychiatric monitoring were crucial for recovery.

## Abstract

Delusions of parasitosis, also known as delusional parasitosis or Ekbom syndrome, is a rare psychiatric disorder characterized by a fixed belief in a bug infestation, despite the absence of clinical evidence. It often co-occurs with other psychiatric conditions such as depression, anxiety, and schizophrenia. In this case, a 50-year-old man with bipolar-type schizoaffective disorder developed delusional parasitosis after a bed bug infestation in his group home. His inadequate adherence to prescribed medications likely exacerbated his symptoms. Treatment involved the consistent administration of clozapine and valproic acid, with dosage adjustments and close monitoring by a psychiatric team. Notably, clozapine's successful role in this case is unique, as delusional parasitosis is typically treated with second-generation atypical antipsychotics.