A 44-YEAR-OLD WOMAN was brought
to hospital by police. Over a period of years she
had isolated herself and her daughter from society,
arousing the concern of neighbours. A scant history
of “schizophrenia”, personality disorder and intellectual
disability was obtained from distant relatives.
Examination revealed classic clinical features of
profound hypothyroidism. In addition, a lump was
found on the patient’s ring finger. Her mental state
necessitated admission, after a psychiatric consultation,
as an involuntary patient.
Investigations confirmed the diagnosis of hypothyroidism
and indicated anaemia due to iron deficiency. An
x-ray of the lump revealed a wedding ring totally
encased in the soft tissue. The patient was started
on thyroxine and antipsychotic medication and transferred
to a psychiatric institution, with marginal improvement
in her mental state. Her daughter was removed to
the care of child welfare authorities. The wedding
ring was surgically removed. Histopathological examination
of the lump revealed a foreign body granuloma with
chronic low-grade Staphylococcus aureus infection.
*originally published by The
Medical Journal of Australia
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