A Case of Protracted Alcohol Withdrawal Syndrome: Resistant Lilliputian Hallucinations with Tremor

In Sri Lanka WHO estimates 3.1% of the population to have alcohol used disorder and predicts that nearly 50% of them can present with alcohol withdrawal syndrome.

We describe a 51 year old male with the back ground history of alcohol abuse for 20 years duration and series of adverse life events facilitating him to develop severe alcohol used disorder and depression. When he presented to us, he exhibited features of major depression with suicidal thoughts and evidence of alcohol withdrawal syndrome according to DSM V criteria. He also had minor cognitive impairment according to MMSE.

After two months of inward treatments, he continued to have disturbing Lilliputian hallucinations, tremors and sleep disturbances which made us to diagnose him having protracted alcohol withdrawal syndrome after considering the other possibilities like major depression with psychotic symptoms, lewy body dementia and psychotic disorder with mood symptoms. His cognitive impairment can be explained by reduced attention and concentration together with low literacy, therefore the diagnosis of pseudo dementia secondary to depression was made.

This case illustrated us the multi-faceted presentations of alcohol used disorder which ultimately posing significant burden to the patient, family, society and also to the free health care system in the country.