The mirror has two faces: A unique case of delusional parasitosis with Cotard's syndrome in a tertiary care hospital in South India

Delusional parasitosis is a psychiatric disorder wherein a person strongly believes themselves being infected by a parasite. Cotard's syndrome is a neuropsychiatric disorder of rarity that occurs as nihilistic delusions ranging from denial of the existence of body parts to negating one's existence. Both could be either primary or secondary to other mental disorders such as depression and schizophrenia. We present a case report where Mr. R, a middle-aged male of lower socioeconomic status, of agrarian background presented with marked depressive features for the past 2 years with a significant history of similar complaints 5 years back. A provisional diagnosis of recurrent depressive disorder (RDD), current episode-severe depression without psychotic symptoms was made with treatment initiation. In subsequent follow-ups, Mr. R reported that his lungs are destroyed and one of his lungs and heart were nonexistent causing him breathing difficulty, and all were a consequence of the organisms devouring his organs. Antipsychotic was hiked to the maximum dose with continued antidepressants, and electroconvulsive therapy was given in inpatient treatment, considering the diagnosis of RDD's current episode of severe depression with psychotic symptoms (delusional parasitosis with Cotard's syndrome). A dual clinical presentation of delusional parasitosis with co-existant Cotard's syndrome secondary to depressive disorder is uncommon and thereby being discussed. Whether Cotard's can be subsumed under the umbrella of delusional parasitosis or is an evolving entity in itself made this clinical scenario intriguing.