When the body is blamed: Klingsor syndrome in psychotic depression

Genital self-mutilation is a rare psychiatric emergency, most often linked to schizophrenia, with limited reports in affective disorders. We describe a 60-year-old man with recurrent depressive disorder with psychotic features who developed mood-congruent delusions of guilt and nihilism, believing that his genitals were decaying and required removal. This led to self-inflicted scrotal injury and unilateral orchiectomy. Clinical features favored psychotic depression over schizophrenia. Treatment with antidepressants and antipsychotics resulted in full remission. This case highlights Klingsor syndrome in psychotic depression and underscores the importance of early identification of high-risk delusional themes to prevent irreversible self-harm and morbidity.