A case report of Capgras syndrome with multiple imposters: a unique presentation of a rare syndrome

Purpose
This case study presents an unusually severe variant of Capgras syndrome involving multiple imposters, which is consi­dered a rare presentation.

Case description
A 37-year-old male with schizophrenia exhibited complex delusional misidentification involving his parents, siblings, and ex-spouse, whom he believed had each been replaced by hundreds of different imposters. These imposters were diffe­rentiated by subtle physical and behavioral features. The delusional system extended to include persecutory beliefs involving secret organizations and supernatural entities. This elaborate form of serial substitution, rarely reported in the literature, reflects a highly systematized psychotic process and highlights the breadth of misidentification phenomena. Clinical assessment supported a diagnosis of schizophrenia with prominent delusional misidentification.

Comment
The case adds to the growing recognition of how Capgras syndrome can manifest in atypical and exaggerated forms, raising important questions about the underlying neurocognitive and affective mechanisms driving these beliefs. Awareness of such presentations is crucial for accurate diagnosis and conceptual understanding.