‘Ik ben vermoord’: Het syndroom van Cotard door retrotonsillair abces

Cotard's syndrome is a rare and severe neuropsychiatric disorder characterized by nihilistic delusions, where patients believe they are dead or do not exist. It's often associated with depression or schizophrenia but may also occur secondary to somatic conditions such as epilepsy, brain tumors, and neurodegenerative diseases. This case involves a 30-year-old man with no prior psychiatric history, who was brought to the emergency department due to confusion and the delusion that he was dead. Examination revealed a retrotonsillar abscess. Although the patient initially lacked classic delirium features such as disorientation and hallucinations, he later developed cognitive and behavioral disturbances, leading to a diagnosis of delirium. Treatment with antibiotics and antipsychotics resulted in rapid clinical improvement and remission of the Cotard delusion. This case highlights the importance of considering delirium in the differential diagnosis of acute psychosis, even in atypical presentations, and emphasizes the need for integrated medical and psychiatric care.