Ekbom Spectrum Psychosis Associated with 24-hour Continuous Subcutaneous Foslevodopa/Foscarbidopa Infusion in Parkinson’s Disease
4 affiliations
- 1Neurology Unit, University Hospital of Cagliari, Cagliari, Italy
- 2Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
- 3Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
- 4Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
Abstract
Continuous subcutaneous foslevodopa/foscarbidopa infusion (CSFLI) is an emerging treatment for advanced Parkinson’s disease (PD). We report atypical psychosis with Ekbom-like somatic hallucinations during CSFLI. A 74-year-old man with a 16-year history of PD (Hoehn and Yahr stage 3), mild cognitive impairment (Montreal Cognitive Assessment 25/30), and previous mild dopamine agonist-induced visual hallucinations received CSFLI for disabling motor fluctuations, dyskinesias, nocturnal rigidity, and severe morning akinesia inadequately controlled by oral therapy. Initial treatment was well tolerated, reducing OFF time, dyskinesias, and sleep disturbance. Because of recurrent motor fluctuations and nocturnal akinesia, infusion parameters were progressively increased to a daytime base rate of 0.48 ml/h and a nocturnal low-rate of 0.38 ml/h, corresponding to an estimated levodopa equivalent daily dose of approximately 1,868 mg/day. Seventy-two hours after ciprofloxacin initiation for an infected subcutaneous nodule, the patient developed vivid visual hallucinations that evolved into Ekbom-like somatic hallucinations, described as worms moving beneath the skin, leading to superficial self-inflicted lacerations. Orientation remained preserved and no delirium features were observed. Initial reduction of infusion parameters, safinamide discontinuation, and quetiapine produced only partial benefit. A subsequent selective reduction of the nocturnal low-rate from 0.36 to 0.30 ml/h was associated with a clinically meaningful reduction in psychotic symptoms, although residual hallucinations and worsening morning akinesia persisted. This case suggests that psychosis during CSFLI may reflect the interaction between neuropsychiatric vulnerability, ciprofloxacin exposure, and sustained nocturnal dopaminergic stimulation. Although causality cannot be inferred, careful nocturnal titration may help clinicians recognize and manage atypical psychotic manifestations early in susceptible patients.
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BibTeX
@article{meloni2026ekbom,
title = {{Ekbom Spectrum Psychosis Associated with 24-hour Continuous Subcutaneous Foslevodopa/Foscarbidopa Infusion in Parkinson’s Disease}},
author = {Mario Meloni and Fabrizio De Ascaniis and Gianni Orofino and Massimo Marano and Martina Mulas and Monica Puligheddu and Marcello Mario Mascia},
journal = {Clinical Psychopharmacology and Neuroscience},
year = {2026},
month = oct,
doi = {10.9758/cpn.26.1449},
url = {https://doi.org/10.9758/cpn.26.1449},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Ekbom Spectrum Psychosis Associated with 24-hour Continuous Subcutaneous Foslevodopa/Foscarbidopa Infusion in Parkinson’s Disease
AU - Mario Meloni
AU - Fabrizio De Ascaniis
AU - Gianni Orofino
AU - Massimo Marano
AU - Martina Mulas
AU - Monica Puligheddu
AU - Marcello Mario Mascia
PY - 2026
DA - 2026/10/30
JO - Clinical Psychopharmacology and Neuroscience
DO - 10.9758/cpn.26.1449
UR - https://doi.org/10.9758/cpn.26.1449
AB - Continuous subcutaneous foslevodopa/foscarbidopa infusion (CSFLI) is an emerging treatment for advanced Parkinson’s disease (PD). We report atypical psychosis with Ekbom-like somatic hallucinations during CSFLI. A 74-year-old man with a 16-year history of PD (Hoehn and Yahr stage 3), mild cognitive impairment (Montreal Cognitive Assessment 25/30), and previous mild dopamine agonist-induced visual hallucinations received CSFLI for disabling motor fluctuations, dyskinesias, nocturnal rigidity, and severe morning akinesia inadequately controlled by oral therapy. Initial treatment was well tolerated, reducing OFF time, dyskinesias, and sleep disturbance. Because of recurrent motor fluctuations and nocturnal akinesia, infusion parameters were progressively increased to a daytime base rate of 0.48 ml/h and a nocturnal low-rate of 0.38 ml/h, corresponding to an estimated levodopa equivalent daily dose of approximately 1,868 mg/day. Seventy-two hours after ciprofloxacin initiation for an infected subcutaneous nodule, the patient developed vivid visual hallucinations that evolved into Ekbom-like somatic hallucinations, described as worms moving beneath the skin, leading to superficial self-inflicted lacerations. Orientation remained preserved and no delirium features were observed. Initial reduction of infusion parameters, safinamide discontinuation, and quetiapine produced only partial benefit. A subsequent selective reduction of the nocturnal low-rate from 0.36 to 0.30 ml/h was associated with a clinically meaningful reduction in psychotic symptoms, although residual hallucinations and worsening morning akinesia persisted. This case suggests that psychosis during CSFLI may reflect the interaction between neuropsychiatric vulnerability, ciprofloxacin exposure, and sustained nocturnal dopaminergic stimulation. Although causality cannot be inferred, careful nocturnal titration may help clinicians recognize and manage atypical psychotic manifestations early in susceptible patients.
SN - 1738-1088
SN - 2093-4327
ER -