Othello syndrome as an early manifestation of Alzheimer's disease: an anatomoclinical case study

Othello syndrome (OS) is characterized by pathological jealousy toward one's spouse, usually marked by delusions of infidelity. We report the first case of OS in Brazil, similar to the case described by Alzheimer in 1906, in a 54-year-old right-handed patient diagnosed with Alzheimer's disease (AD). The diagnostic workup included a clinical history and a positive family history of dementia, the Clinical Dementia Rating (CDR) scale, the Edinburgh Handedness Inventory, and the Mini-Mental State Examination (MMSE). Electroencephalography revealed slow waves predominantly in the bilateral temporo-frontal regions. Cranial computed tomography showed diffuse cortico-subcortical atrophy compatible with the patient's age, as well as bilateral globus pallidus calcifications. Cerebral single-photon emission computed tomography revealed hypoperfusion in the medial frontal and bilateral temporal regions, more pronounced on the left - particularly in the inferomedial portion of the left temporal lobe - along with mild supratentorial ventricular dilatation. Postmortem examination revealed moderate bilateral fronto-temporo-parietal atrophy, and microscopy showed the presence of senile plaques and neurofibrillary tangles. We report an unusual case of OS as the initial clinical manifestation, later diagnosed as AD.