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This case report describes a 73\u2010year\u2010old female diagnosed with Lewy body dementia (LBD) who developed CS, manifesting as the delusional belief that her deceased husband had been replaced by an imposter. The clinical presentation was complex, including pronounced sleep disturbances, cognitive decline, behavioral anomalies, and visual hallucinations, necessitating a thorough differential diagnosis process. We detail the patient\u2019s history, clinical findings, and the investigations undertaken, including brain imaging and cognitive assessments. The management approach involved a personalized treatment plan integrating Lithium sulfate, Citalopram, and Lurasidone, alongside psychosocial interventions. While a partial improvement was observed, the case underscores the complexities of managing CS in the context of LBD, highlighting the need for tailored and multidisciplinary approaches to care. 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