Ekbom syndrome (delusional infestation) is a rare psychotic disorder characterized by a fixed belief of parasitic infestation in the absence of objective medical evidence. Positioned at the intersection of psychiatry, dermatology, and neurology, it may arise as a primary condition or secondary to underlying medical, psychiatric, or iatrogenic factors. Emerging evidence suggests that chronic inflammatory and neuroimmune processes may contribute to altered somatic perception and the development of delusional beliefs in vulnerable individuals. We present a case of a 55-year-old female with no prior psychiatric history who developed a progressive neuropsychiatric syndrome following cosmetic biopolymer injections in the face, hands, feet, and dorsal region, performed approximately one and a half years prior in a non-medical setting. Symptom onset was insidious, initially marked by progressive cutaneous changes, predominantly hyperpigmentation, which evolved into a persistent and disproportionate preoccupation with her bodily state. Over time, this was accompanied by a generalized anxiety syndrome characterized by psychomotor agitation, insomnia, somatic hypervigilance, muscle tension, and ruminative thoughts centered on perceived physical alterations. The clinical course culminated in the emergence of a fixed belief of infestation beneath the skin, consistent with secondary Ekbom syndrome. Comprehensive laboratory evaluation and cross-sectional imaging excluded an identifiable organic etiology. Treatment with an antipsychotic agent combined with a selective serotonin reuptake inhibitor was initiated, alongside referral for multidisciplinary management involving dermatology and plastic surgery. This case underscores cosmetic biopolymer exposure as a potential and underrecognized precipitating factor for secondary Ekbom syndrome, possibly mediated through chronic inflammatory responses and dysregulation of body perception. It highlights the need for early recognition of evolving neuropsychiatric symptoms in patients with prior cosmetic interventions and supports an integrated, multidisciplinary approach to prevent diagnostic delay, inappropriate treatments, and chronic progression in complex psychodermatological presentations.
Galindo et al. (Wed,) studied this question.