A rare case report of Lilliputian and Brobdingnagian hallucinations in a case of pemphigus vulgaris

Pemphigus vulgaris is an autoimmune disorder characterized by intraepithelial, blistering lesions affecting the skin and mucous membrane. Psychiatric manifestations of pemphigus vulgaris are generally described secondary to steroid and immunosuppressant therapy though recent studies highlight independent association of pemphigus with psychotic disorders. We describe a unique development of Lilliputian hallucinations, their transformation into Brobdingnagian hallucinations on treatment with steroids and gradual resolution back to Lilliputian status on treatment with risperidone. Earlier Lilliputian hallucinations have been described in a case of Charles Bonnet syndrome, Balint syndrome, alcohol withdrawal delirium, head injury and dementia. This unique phenomenon carries it significance in the literature from psychopathological perspective.