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A 49-year-old man with right temporal lobe epilepsy developed the chronic delusion that his body emitted a foul odor (olfactory reference syndrome). Before the delusional symptoms, he had partial seizures with unpleasant olfactory hallucinations. Subsequently ictal olfactory symptoms abated but a disabling delusional syndrome developed. The only prior case of the olfactory reference syndrome in a patient with epilepsy had a right frontal lesion. The case further supports the association of right hemisphere lesions and delusional disorders.