title: Interdisciplinary Differential Diagnosis and Care of a Patient with Atypical Delusional Parasitosis due to early HIV-related Dementia.
abstract: OBJECTIVE
  To provide a differential diagnosis and recommendations for care for an individual with suspected delusional parasitosis secondary to human immunodeficiency virus (HIV).
  
  
  METHODS
  A 62-year-old male with sexually acquired, chronic, and well-managed HIV infection was referred for neuropsychological evaluation and treatment recommendations following extensive self-manipulation of a sternoclavicular cystic mass and superficial skin lesions over most of his body. The patient reported that he had pulled long calcified tendrils out of the mass over a period of several weeks and that "encapsulated fat" was flowing beneath his skin.
  
  
  RESULTS
  Numerous lab panels were negative for any acute medical pathology. Clinical neuroimaging was unremarkable. Neuropsychological evaluation revealed a profile consistent with mild neurocognitive disorder due to HIV. Medical and behavioral recommendations were made for the management of delusional thought processes consistent with atypical delusional parasitosis and other symptoms. The patient was responsive to carefully crafted provider feedback and his delusional and somatic symptoms decreased significantly with risperidone.
  
  
  CONCLUSIONS
  This case illustrates the utility of neuropsychological assessment and provider feedback in the diagnosis and care of HIV-related neurocognitive disorder, the context of a delusional disorder.
authors.affiliation: a Moss Rehabilitation Research Institute , Elkins Park, PA , USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Medaglia
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: VanKirk
authors.forename: Cameron B
authors.initials: CB
authors.lastname: Oswald
authors.forename: L W Preston
authors.initials: LW
authors.lastname: Church
mesh_terms: D015526:AIDS Dementia Complex / Q000150:complications* / Q000175:diagnosis*; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D015928:Cognitive Behavioral Therapy; D003560:Cysts / Q000175:diagnosis / Q000628:therapy; D063726:Delusional Parasitosis / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D003863:Depression / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000150:complications; D008875:Middle Aged; D059906:Neuroimaging; D009483:Neuropsychological Tests; D010348:Patient Care Team; D012867:Skin / Q000473:pathology*; D011795:Surveys and Questionnaires
chemical_list: D014150:Antipsychotic Agents
keywords: HIV; Neuropsychological assessment; Treatment planning.