Chen Xialing Ann, Kelsey John
Psychiatry, University of California San Francisco, San Francisco, USA.
Psychiatry, Sutter Health California Pacific Medical Center, San Francisco, USA.
Cureus. 2025 Mar 27;17(3):e81305. doi: 10.7759/cureus.81305. eCollection 2025 Mar.
Attention-deficit hyperactivity disorder (ADHD) is generally treated with stimulant medications without significant complications. Delusional parasitosis (Ekbom syndrome) can occur secondary to ADHD treatment. It is a rare condition defined as having a fixed, false belief that one is infected with insects, parasites, or organisms and that one experiences cutaneous sensations without any clinical evidence of infestation. Although stimulant treatment with methylphenidate or mixed amphetamine salts has been associated with delusional parasitosis, there is yet a case in the literature illustrating delusional infestation secondary to lisdexamfetamine. The following case is unique in that lisdexamfetamine caused delusional parasitosis in a 53-year-old man with ADHD who previously tolerated mixed amphetamine salts and armodafinil without side effects. The discontinuation of lisdexamfetamine, coupled with a second-generation antipsychotic, quickly resolved the delusion. For those who may prescribe lisdexamfetamine or treat patients with ADHD, it is crucial to carefully assess medication use, as discontinuation or dose adjustment of the suspected causative drug can have a positive impact on the course of delusional parasitosis.
注意力缺陷多动障碍(ADHD)通常用兴奋剂药物治疗,且无明显并发症。妄想性寄生虫病(埃克博姆综合征)可继发于ADHD治疗。这是一种罕见病症,定义为存在一种固定、错误的信念,即认为自己感染了昆虫、寄生虫或生物体,并且在没有任何感染临床证据的情况下出现皮肤感觉。尽管使用哌甲酯或混合苯丙胺盐进行兴奋剂治疗与妄想性寄生虫病有关,但文献中尚无利司地芬太尼继发妄想性感染的病例。以下病例的独特之处在于,利司地芬太尼在一名患有ADHD的53岁男性中引发了妄想性寄生虫病,该男性此前耐受混合苯丙胺盐和阿莫达非尼且无副作用。停用利司地芬太尼并联合使用第二代抗精神病药物后,妄想迅速得到缓解。对于可能开具利司地芬太尼处方或治疗ADHD患者的人来说,仔细评估用药情况至关重要,因为停用或调整疑似致病药物的剂量可能对妄想性寄生虫病的病程产生积极影响。