Fregoli syndrome in an adolescent with Moyamoya disease.
Nisha Rajan, Kiruthika Asokan, Venkatesh Karthik et al.
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Case in brief
An early adolescent with known Moyamoya disease developed acute psychosis after a febrile illness accompanied by headache and vomiting. Symptoms included auditory hallucinations, persecutory delusions, emotional lability and Fregoli syndrome, in which strangers were perceived as a familiar person in disguise. Imaging showed bilateral internal carotid artery narrowing and extensive collateral networks; infectious, autoimmune and metabolic evaluations were unremarkable. After superior temporal artery–middle cerebral artery bypass with encephalo-duro-arterio-myo-synangiosis, the psychotic symptoms resolved, and the patient returned to baseline functioning within 1 month.
What made this case unusual
The psychosis included Fregoli syndrome, an unusual delusion of misidentifying different strangers as one familiar person, in an adolescent with Moyamoya disease.
Diagnostic / clinical pearl
Abrupt-onset psychosis in a child with Moyamoya disease warrants consideration of a cerebrovascular cause, even without major neurological deficits.