Delusional Parasitosis Without Cutaneous Presentation: "I Have Moths in My Belly"

Delusional parasitosis is a psychiatric illness characterized by a false belief of a parasite infestation, despite evidence to the contrary. The disorder typically presents as a dermatologic condition since patients often itch and pick at their skin to relieve the perceived infestation. Patients often have numerous cutaneous lesions that never heal due to persistent picking. Another hallmark presentation known as the "matchbox sign" has patients collecting "evidence" of their perceived infestation. This patient believed that he had "moths" infesting his stomach, creating "web-like" structures that spread as far as his nostrils. In this case study, we describe this presentation of the disorder and contextualize our patient in the current literature on delusional parasitosis.