Hypochondriacal delusion in an elderly man with good response to electroconvulsive therapy but complicated with febrile reaction

In this case report, we present an elderly gentleman with prominent somatic delusions associated with depressive features. He was diagnosed to have severe depressive episode with mood congruent psychotic symptoms and was resistant to both pharmacological and psychological intervention.There was a differential diagnosis of delusional disorder, somatic subtype, resulting in a secondary depressive episode in view of his persistent somatic delusions which appeared more distressing and more prominent than his mood symptoms. Chronologically, his depressive symptoms had been there first, followed by more and more somatic complaints therefore he was concluded to have treatment resistant depression. Electroconvulsive therapy (ECT) was started with significant improvement especially for his hypochondriacal delusions. However, the ECT was complicated by recurrent febrile reaction which had close temporal relationship with each ECT session but was noted to be benign in nature. This patient has reminded us that psychotic depression is common in the elderly and may have atypical presentation. ECT is an effective treatment option for those resistant to pharmacological and psychological intervention. It has resulted in a fast and complete recovery for hypochondriacal delusion. Febrile reactions might be associated with ECT and it is important to rule out other causes.