Marchiafava-Bignami Disease is a rare complication in malnourished patients with chronic alcohol use. Due to its rarity, its pathogenesis is poorly understood. Patients suffering from Marchiafava-Bignami Disease can present with a plethora of symptoms including acute change in mental status, dementia, seizures and neurological dysfunction. This condition is characterised by corpus callosum demyelination with reported cases of white matter involvement.

To highlight the possibility that patients exhibiting predominant psychiatric symptoms with a history of chronic alcohol use might also be suffering from Marchiafava-Bignami Disease and that such a diagnosis should not be ruled out purely because of the psychiatric symptoms.

We report a 41-year-old man who presented with sub-acute cognitive decline, poorly defined psychotic symptoms and minimal neurological signs. MRI showed atrophy of the corpus callosum, consistent with Marchiafava-Bignami Disease. Despite timely diagnosis and adequate treatment, his psychotic symptoms have remained persistently debilitating.

During our review, the psychiatric symptoms proved to be a red-herring which masked the real diagnosis of this patient. However, based on the MRI findings, he was finally diagnosed with Marchiafava-Bignami Disease. Arrangements have been made to place him in a rehabilitation setting with regular neurological follow-ups to assess disease progression, which would facilitate further management.

This case highlights an atypical presentation of Marchiafava-Bignami Disease and raises the importance of thorough investigations in patients with a long history of alcohol consumption and the need to have a high index of suspicion. Concomitant conditions associated with chronic alcohol use should also be considered.