Osteomyelitis of zygoma in a schizophrenia patient

A 43-year-old man with schizophrenia presented to our hospital with appetite loss and general fatigue lasting 1-2 months. His face was flared and swollen, and he shed tears of pus. He could answer any questions, but never complained of pain. We found dacryocystitis with subcutaneous abscess with contiguous osteomyelitis with culture-proven Stapylococcus aureus, and diabetes mellitus (DM). Although DM neuropathy was mild, he did not complain of pain. We searched thoroughly for other abscesses since S aureus grew in all four of his blood cultures. We re-examined his whole body by CT, which revealed multiple muscle abscesses in both legs. It is reviewed that schizophrenia patients are relatively insensitive to physical pain. Thus, we should keep in mind that they may have multiple, unpredictable and rare underlying diseases, such as our case. Careful and thorough examinations are essential for treatment in schizophrenia patients.