A 66-Year-Old Man Who Heard His Deceased Spouse's Voice

Jeffrey S. Forrest, MD; Steven Kendell, MD

Disclosures

January 31, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 66-year-old man was admitted to the hospital for stabilization and workup after sustaining numerous injuries from an apparent fall, including a distal radius (Colles) fracture. Upon admission, the patient was fully oriented. He explained that he fell trying to get out of his bathtub (Figure 1).

Figure 1.

The patient insisted that he had otherwise been feeling fine and downplayed the need for further assistance. He requested medication for his headache. The patient denied substance abuse.

On the second day of admission, the patient developed worsening tremor and diaphoresis. He began to pick at his skin, stating that he wants to get rid of the "bugs that are crawling on him." The patient attempted to pull his intravenous (IV) lines out and turned his head rapidly, stating that he could hear the voice of his deceased spouse. He believed he was in a seafood restaurant.

The patient's medical history of note included atrial fibrillation, hypertension, and peripheral vascular disease. During admission, he had stated that he could not remember whether he had been taking his blood pressure medication correctly.

The patient stated that he has no family since the passing of his spouse. Family medical history was unobtainable.

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