[A case of delusional parasitosis in severe heart failure. Olanzapine within the framework of a multimodal therapy].

The case of a 73-year-old male with delusions of parasitosis (DP) is presented. He complained about severe itching of the limbs and the genital region as well as abnormal body and pubic hair that he believed to be parasites. The symptoms occurred over the course of several years together with severe heart diseases (New York Heart Association class III, atrial fibrillation, tricuspid regurgitation) and chronic edema of the lower leg. The pruritus was also based on chronic, self-induced skin lesions due to aggressive disinfection and tearing out of body hair. After ruling out true infection, a multimodal DP therapy was initiated. Instead of the standard neuroleptic drug pimozide, olanzapine was used because of its better tolerability in patients with increased cardiac risk (i.e., borderline prolonged QTc time). At discharge, the DP had partially remitted. Substantial improvement in the heart and skin diseases under specific treatment contributed substantially to the success of the therapeutic regimen. This case hints at (1) the effectiveness of olanzapine in DP and (2) the importance of general medical conditions in the therapeutic approach to DP.