History of Morgellons disease: from delusion to definition

Figures & data

Table 1 Case studies claiming delusional etiology of Morgellons disease

Study	Case	Complaint	Fibers present on skin	Fibers studied	Detection of spirochetes	Underlying conditions
Ohn et al^Citation75	30-year-old female	Fibers under skin, stinging in fingers	One fiber on dermal side of biopsy	Lost during processing	Yes, but different methods in abstract and text indicated negative results	Not reported
Ranka et al^Citation71	50-year-old female	Fibers coming out of skin	Not reported	Patient supplied specimen, visual identification	Not reported	Not reported
Roncati et al^Citation72	49-year-old female	Fibers coming out of skin	Yes, gray spots containing fibers	Yes, used SEM/EDS, methods not sufficient to determine source of keratin fibers	Yes, used serology, but did not indicate if positive or negative, methodology insufficient	HCV infection, “myoclonies” [sic]
Sandhu and Steele^Citation73	65-year-old female	Sensations of fibers in eyelid, “wormy things” coming from skin, self diagnosed with MD	Not reported	Not reported	Not reported	Ectropion
Mortillaro et al^Citation70	37-year-old female	“Black substance” coming out of hands	Not reported	Not reported	Not reported	Amphetamine and buprenorphine use
Fellner^Citation67 Case 1	44-year-old female	Crawling sensations, strings and parasites coming out of eyelids, eyelashes, and ears	Not reported	Not reported	Not reported	History of cocaine and heroin use, seborrheic dermatitis
Fellner^Citation67 Case 2	90-year-old female	Worms and strings coming out of body	Not reported	Not reported	Not reported	Senile dementia, Trichuris infection
Altunay et al^Citation66 Case 1	65-year-old female	Pruritis, stinging on head, paper and wood emerging from skin	Not reported	Looked at patient-supplied specimen	Not reported	Vitamin B12 deficiency, cranial trauma confirmed by MRI, hypertension
Altunay et al^Citation66 Case 2	71-year-old female	Pruritis, sand-like material out of skin, belief of infection	Not reported	Indicated specimens were presented, but did not indicate if they looked at them	Not reported	Vitamin B12 deficiency, psychosis not otherwise specified
Altunay et al^Citation66 Case 3	53-year-old female	Burning sensations, worms coming out of skin	Not reported	Not reported	Not reported	Vitamin B12 deficiency, hypercholesterolemia, hyperglycemia, hypothyroidism, cultural beliefs may have been a factor
Altunay et al^Citation66 Case 4	27-year-old female	Bugs crawling under scalp and hair loss	Not reported	Not reported	Not reported	Vitamin B12 deficiency, schizoaffective disorder
Altunay et al^Citation66 Case 5	65-year-old female	Pruritus and bugs on head	Not reported	Looked at dandruff flakes for lice	Not reported	Brief psychotic disorder, vitamin B12 deficiency
Altunay et al^Citation66 Case 6	65-year-old female	Pruritus and crawling sensations, believed a snake migrated in her body	Not reported	Not reported	Not reported	Schizophrenia
Dewan et al^Citation62 Case 1	68-year-old female	Cutaneous erosions and hair loss, thought a Mahonia bush was inside her	Not reported	Patient brought specimen, described as normal, methodology not specified	Not reported	Reactive depression
Dewan et al^Citation62 Case 2	63-year-old male	Fibers in scalp, eyebrows, and ears	Not reported		Not reported	Previous infestation with lice, used LSD and other hallucinogens
Grosskopf et al^Citation64	39-year-old woman	Insect and hair emerging from maxillary gingiva	Not reported	Patient supplied samples from feet, visually identified as hair	Not reported	Bipolar disorder, admitted rubbing gingiva with cloth
DeBonis and Pierre^Citation61	46-year-old male	Pursued by Japanese mafia, crawling sensations, cocoons emerging from body, self-diagnosed with MD	Not reported	Not reported	Not reported	Used cannabinoids, ivermectin toxicity
Robles et al^Citation43 Case 1	60-year-old male	Reported hard hair bulbs, and that cartilage and fibrous material emerged from skin	Not reported	Not reported	Not reported	Secondary bacterial infection, treated successfully with doxycycline
Robles et al^Citation43 Case 2	35-year-old female	Reported black fibers in skin, denied parasites or organisms	Not reported	Not reported	Not reported	Secondary bacterial infection, treated successfully with doxycycline
Robles et al^Citation43 Case 3	50-year-old female	Reported rocks and fibrous threads in skin	Not reported	Not reported	Not reported	Not reported
Freudenreich et al^Citation58	43-year-old male	Believed he had parasites, self-diagnosed with MD	Not reported	Not reported	Not reported	HIV infection
Reid and Lio^Citation60	47-year-old female	Painful lesions with thread-like fibers	Not reported	Brought in bloody specimens on paper towels, did not indicate they were studied	Not reported	Sepsis, diabetes, restless-leg syndrome, fibromyalgia
Dovigi^Citation57	61-year-old female	Reported fibers coming out of oral lesion	Yes, three fibers removed	SEM showed little microstructure and homogeneous cross section; spectrum profile showed primarily carbon and small amount of oxygen, consistent with synthetic fiber	Not reported	Hyperthyroidism, osteoporosis, history of mononucleosis and hepatitis
Harth et al^Citation59	55-year-old female	Fibers and barbs in skin, fatigue, cognitive dysfunction, night sweats, sinus pressure	Not reported	Brought in skin specimens, did not indicate they were studied	Not reported	Not reported
Vila-Rodriguez and Macewan^Citation56	57-year-old male	Erythematous lesions, self-diagnosed with MD	Not reported	Not reported	Not reported	Not reported
Bhandary et al^Citation55 Case 1	23-year-old female	Reported a bug in ear	Not reported	Not reported	Not reported	Not reported
Bhandary et al^Citation55 Case 2	70-year-old male	Complained of a bug in ear	Not reported	Not reported	Not reported	Not reported
Bhandary et al^Citation55 Case 3	58-year-old male	Complained of a bug emerging from nose, crawling and itching sensations on nose	Not reported	Not reported	Not reported	Not reported
Murase et al^Citation54	45-year-old female	Self-diagnosed with MD	Not reported	Not reported	Not reported	Not reported

Abbreviations: HCV, hepatitis C virus; SEM/EDS, scanning electron microscopy/energy-dispersive spectroscopy; MD, Morgellons disease; MRI, magnetic resonance imaging.

Figure 1 Embedded cutaneous blue and white filaments.

Notes: Note elaborate arrangement with branching and tapered ends; magnification 50×.

Figure 2 Longitudinal sections of filaments originating in the basal layer of the epidermis adjacent to the dermis; magnification 400×.

Figure 3 Filaments remaining embedded in deeper layers of skin after removal of a callus; magnification 100×.

Figure 4 (A) A filamentous follicular cast. White filaments originating on the outer follicular sheath are growing in a coiled manner. Magnification 50×. (B) Pili multigemini, a common finding in Morgellons disease patients, with multiple hairs forming from a single bulb. Magnification 50×.

Figure 5 (A) Thickened keratinized follicular casts in a Morgellons disease specimen that grew inward into the dermis. Note the clear inward-growing hair. Magnification 100×. (B) Specimen from a bovine digital dermatitis lesion with similarities to human Morgellons specimens. Note thickened keratin projections and the threadlike blue filament (lower part of specimen). Magnification 50×.

Figure 6 Single spirochete from a Morgellons disease skin specimen immunostained for detection of Borrelia. Magnification 1,000×.

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