Genital self-mutilation in a patient with frontotemporal dementia

A case of a patient with frontotemporal dementia (FTD) who mutilated his penis is presented. Brain magnetic resonance imaging, single-photon emission computed tomography abnormalities and cognitive assessment are described. Genital self-mutilation (GSM) is a disturbing though yet not described symptom in FTD. A 60-year-old patient presented with a two-year history of social withdrawal and loss of attention to household responsibilities. He was hospitalized and eventually diagnosed with FTD. One day, the nurses observed that his penis was swollen and lacerated. It was discovered that the patient had mutilated his penis with a spoon. He did not have any insight and he completely denied his act. FTD is the second most common cause of dementia in people younger than 65 years. It is characterized by personality changes and impaired social conduct and represents the behavioral variant of the three clinical presentations of frontotemporal lobar degeneration. Sociopathy is a well described but underappreciated phenomenon in FTD patients. It is characterized by decreased insight and decreased awareness of patient’s actions and their impact. In patients presenting with behavioral changes and GSM, FTD is one of the diagnoses to be taken in consideration.