Primary or secondary delusional parasitosis is a phenomenon that often has a clear and memorable presentation. Stimulants and cocaine in particular, have a long history of producing psychotic episodes. A famous example of these is the 'cocaine bugs”. It has been noted that this is part-delusion and part-hallucination. There have been reports of delusions of parasitic infestation occurring in psychotic disorders as well. We are reporting a case of one patient with delusions of parasitic infestation who self inflicted a trauma to his ear by attempting to remove “a bug”.

1. 1. Obtain a thorough substance, psychiatric and medical history.

2. 2. A close collaboration between dermatologist, medical team and psychiatrist involved in the case is recommended.

3. 3. Antipsychotic and substance use treatment when stimulant use disorder is identified is identified.

1. 1 Identify the etiology of delusional parasitosis.

2. 2 Prompt diagnosis.

3. 3 Implement adequate treatment.

We are reporting a case of a patient with delusions of parasitic infestation and the review of relevant literature.

On admission patient’s urine drug screen was positive for amphetamines and cocaine. He had a questionable history of Schizoaffective disorder. Parasitic infestation was rulled out by the medical team. Pt achieved symptoms resolution during psychiatric hospitalization and treatment with antipsychotics.

Patients with delusions of parasitic infestation can at times present significant danger to self during the attempts to remove 'a parasite”,

therefore a prompt diagnosis and adequate treatment are of great value.