Had a patient in the triage area with these symptoms. Kept saying, "look, there they are" while she scratched her skin raw. Didn't see a thing. Just another nut in the nutbowl, right?
So I presumed.
Bedbugs, scabies, narcotics withdrawal, delusional parasitosis, just plain kookoo.....all plausible explanations.
Then I stumble, days later upon a medical journal with an article on Morgellan's disease, which manifests all the above-mentioned symptoms. Even the CDC has a website addressing the issue.
I hope I washed my hands well that day.