MONOSYMPTOMATIC HYPOCHONDRIACAL PSYCHOSIS COMPLICATED BY SELF-INFLICTED SKIN ULCERATION, SKULL DEFECT AND BRAIN-ABSCESS

Self-inflicted dermatoses are associated with personality disorders an d psychoses, including monosymptomatic hypochondriacal psychosis (MHP) , which is characterized by a delusion involving a particular hypochon driacal concern, We report an unusual case of MHP with severe mutilati on of the skin complicated by a skull defect and brain abscess. The pa tient was a 66-year-old uneducated man who damaged his forehead repeat edly because he believed that a 'toxic root' in the forehead was the s ource of his general ailment, He admitted that the lesions were self-i nflicted. There was no other evidence of psychosis or primary skin dis ease and MHP was diagnosed, Despite initial favourable response to pim ozide, the patient was lost to follow-up for 4 years, during which he continued to damage his forehead and applied corrosive agents, He was then referred with a personality change and a 6 x 4 cm bony defect in the skull, complicated by herniation and abscess of the left frontal l obe, This case represents one of the most severe examples of self-muti lation ever reported. The differential diagnosis of dermatitis artefac ta and the principles of treating MHP are discussed.