A 33-year-old man was brought in by his family because of bizarre behavior. They said he had a mental breakdown years ago but had no psychiatric problems or known substance abuse since then.
The family said he was constantly swearing at people and being argumentative. He had also been drinking heavily, which was unusual for him.
I found him to be loud and aggressive. He would not talk with me but demanded I go outside with him to fight. He got more agitated as we talked until he pulled down his pants, defecated in his hand and threw the feces on the floor.
After appropriate sedation, he was taken to emergency psychiatry.
A man in his early twenties came in by ambulance complaining of abdominal pain, nausea and vomiting. I see people all the time with those complaints so I was expecting to see someone with food poisoning, an intestinal virus or something like that. This was different.
The patient told me that after defecating, he scratched an itch on his face by wiping his index finger across his upper lip and nostrils. It was only then he realized his finger was dirty and he had rubbed feces on his face. He immediately developed crampy abdominal pain, nausea and vomiting. By the time I saw him, he had washed up and was feeling fine.