Statut nosologique du syndrome d’Ekbom : à propos d’un cas

RésuméLe syndrome d’Ekbom, ou délire de parasitose, est une pathologie rare, aux frontières nosographiques floues et qui convoque plus souvent les somaticiens que les psychiatres. Cette conviction d’être infesté par des parasites touche typiquement les femmes d’âge mur ; les patientes veulent apporter la preuve de leur infestation en recueillant des « spécimens » et en les montrant à leur médecin dans un petit récipient, c’est le classique signe de la boîte d’allumette. Nous avons rencontré le cas d’un légionnaire de 36 ans, qui, pour prouver son infestation par des vers, s’est infligé une incision sus-pubienne de 10 cm de long lors de sa consultation avec un médecin somaticien. Ce tableau atypique souligne le polymorphisme que l’on peut rencontrer dans le syndrome d’Ekbom, tant au niveau éthiopathogénique qu’au niveau de la présentation clinique.

ObjectivesDelusional parasitosis is a syndrome which is more familiar to dermatologists or infectious diseases physicians than to psychiatrists. If the Diagnostic and Statistical Manual of Mental Disorders considers this syndrome belongs to delusional disorders, we can question about the psychopathology bases of this disease, regarding to the variety of clinical cases. Through an atypical case of a legionnaire's delusional parasistosis, we aimed to show that this syndrome still have blurred borders because it polymorphism can fit in many diagnoses.PatientA 36-year-old legionnaire consulted a physiatrist for a back pain and self-incised his abdomen to show to the physician he was infested by parasites. The lake of evidences to prove his infestation lead to an hospitalization in our psychiatry department.ResultsAccording to a modern classification like the DSM IV-TR, on one hand our patient's symptoms meet the criteria for the diagnosis of hypochondry, pain disorder, somatic type of delusional disorder, undifferentiated schizophrenia, mixed state, histrionic personality and narcissistic personality. On the other hand, according to a recognized French classification like Guelfi's, these symptoms evoke diagnosis of pathomimesis, hypocondry or hysteria, but they cannot completely correspond to any detailed description.ConclusionThis clinical case shows delusional parasitosis can quote for many diagnosis in modern classification (axis I and II in the DSM IV-TR) but can not completely fufill any diagnosis in Guelfi's one. Could it be a new face of hysteria?