Venugopal Vijay RATNAM, Suranjita MAZUMDAR
Medical Science and Discovery - 2026;13(3):59-63
Objective: Somatic delusions are common in schizophrenia; however, delusional zoopathy -defined as the conviction that macroscopic animals (e.g., reptiles or mammals) inhabit the body -is rare and phenomenologically distinct from classical delusional infestation (Ekbom syndrome), which typically involves microscopic organisms. We report a 35-year-old married woman from Assam with chronic schizophrenia and comorbid hypothyroidism who, following an 11-year illness course characterized by persecutory delusions toward neighbors and family members, third-person auditory hallucinations, self-talking, and inappropriate smiling, developed a fixed belief that a snake had entered through her mouth and was residing in her stomach. Case: This delusion was accompanied by severe abdominal pain, marked restlessness, and prominent cenesthopathic "writhing" sensations attributed to the snake's movements, resulting in persistent demands for abdominal ultrasonography to "detect the snake," despite normal findings and repeated reassurance. The patient showed no response to adequate trials of aripiprazole and olanzapine but demonstrated marked clinical improvement with clozapine 200 mg/day, including reduction in somatic complaints, attenuation of cenesthopathic sensations, and emergence of partial insight. Conclusion: This case illustrates that highly bizarre zoopathic delusions may emerge in chronic, treatment-resistant schizophrenia, highlights the reinforcing role of cenesthopathic hallucinations in somatic delusional conviction, and underscores the importance of addressing both positive psychotic symptoms and aberrant bodily experiences, including timely initiation of clozapine when standard antipsychotics fail.
