- Unexplained destructive nasal lesions in half-brothers: A possible case of Munchausen syndrome by proxy. [Journal Article]
- IJInt J Pediatr Otorhinolaryngol 2019 Apr 25; 123:75-78
- Munchausen syndrome by proxy (MSBP) is a condition diagnosed when a caregiver knowingly fabricates or inflicts illness on another for his/her own gain. Typical cases of MSBP detected by otolaryngolog…
Munchausen syndrome by proxy (MSBP) is a condition diagnosed when a caregiver knowingly fabricates or inflicts illness on another for his/her own gain. Typical cases of MSBP detected by otolaryngologists involve facial trauma or otologic injury, while descriptions involving the nose are rare. Destructive nasal lesions have a broad differential diagnosis and may require visits to numerous specialists, placing strain on both the patient and the healthcare system. Early recognition of MSBP in patients with chronic nasal destruction may prevent such unnecessary strain. We present a case of MSBP involving two half-brothers with unexplainable nasal destruction and discuss the literature and current recommendations for managing the diagnosis.
- Breast surgeons dealing with Munchausen syndrome: A self-induced necrotic phlegmon of the breast treated with surgery, negative pressure and epidermal fractional skin grafting. [Journal Article]
- BJBreast J 2019; 25(3):526-527
- The Incidence of Diagnosis of Munchausen Syndrome, Other Factitious Disorders, and Malingering. [Journal Article]
- BNBehav Neurol 2019; 2019:3891809
- CONCLUSIONS: There is a male predominance for the diagnosis of malingering. An earlier suspicion of a female predominance for Munchausen syndrome is upheld. There is significant underdiagnosing and misdiagnosing for both conditions and for factitious disorders in general. To separate the most serious form of factitious disorders from milder forms and to facilitate more systematic research, we recommend a specific ICD diagnosis for Munchausen syndrome.
- Medical Child Abuse: An Unusual "Source" of Vaginal Bleeding. [Journal Article]
- JPJ Pediatr Adolesc Gynecol 2019 Mar 25
- CONCLUSIONS: Vaginal bleeding is a rare presentation of MCA, but must be considered whenever reported symptomatology does not follow physiologic patterns, respond to standard medical treatment, or correspond to clinical evaluation. Prompt identification is important to prevent further harm.
- Caring for caregivers. [Journal Article]
- GNGeriatr Nurs 2019 Mar - Apr; 40(2):214-216
- Disclosure of caregiver-fabricated illness to a child: A team-based approach to communicating with pediatric patients. [Journal Article]
- CCClin Child Psychol Psychiatry 2019 Jan 09; :1359104518816122
- Clinical practice guidelines for informing children they have been subjected to caregiver-fabricated illness are highly limited in the current literature. This article addresses this issue by offerin…
Clinical practice guidelines for informing children they have been subjected to caregiver-fabricated illness are highly limited in the current literature. This article addresses this issue by offering an ethically informed, psychological approach to the disclosure of this form of abuse to school-aged children and adolescents who have been significantly harmed. A multidisciplinary, staged model of communication which illustrates that truthful communication with children and their families is a necessary component of the recovery process is proposed.
- Munchausen by proxy syndrome mimicking childhood-onset systemic lupus erythematosus. [Case Reports]
- LLupus 2019; 28(2):249-252
- Childhood-onset systemic lupus erythematosus (cSLE) is a chronic inflammatory multisystem autoimmune disease that requires multiple differential diagnoses. Munchausen by proxy syndrome (MBPS) is a fo…
Childhood-onset systemic lupus erythematosus (cSLE) is a chronic inflammatory multisystem autoimmune disease that requires multiple differential diagnoses. Munchausen by proxy syndrome (MBPS) is a form of child abuse, where a caregiver intentionally creates a medical history and induces or fabricates signs or disease in a patient. To our knowledge, there is no case report of MBPS mimicking cSLE diagnosis. We reported herein a 9-year-old male patient, with a history of multiple hospitalizations due to seizures with altered levels of consciousness. The mother reported malar rash, photosensitivity, alopecia, arthralgia, arterial hypertension, macroscopic hematuria, seizure and positive antinuclear antibodies. In the other service, he was treated with intravenous methylprednisolone, prednisone and mycophenolate mofetil. At 8 years and 8 months, he was admitted to our tertiary center with history of fever and macroscopic hematuria. Laboratory examinations were normal, including negative for antinuclear antibodies, anti-double stranded DNA, anticardiolipin, anti-Ro/SSA, anti-La/SSB, anti-RNP and anti-Sm antibodies. Multiple urine cultures revealed the presence of Enterococcus faecium, Acinetobacter sp., Stenotrophomonas maltophilia and Serratia marcescens, without any association with pyuria. At 8 years and 9 months, he was readmitted at emergency room with history of severe fever, headache, vomiting, photophobia, phonophobia and dizziness. The physical examination showed agitation, confusion, ataxic gait, slurred speech, horizontal nystagmus, painful facial expressions, tachycardia and weight loss. Brain magnetic resonance angiography and cerebrospinal fluid analysis were normal. During hospitalization, he had an acute episode of epistaxis and otalgia with excoriation in the auditory canal. At that moment, the suspicion of MBPS mimicking cSLE was raised and phenytoin intoxication was confirmed (peak phenytoin concentration was 45.4 mcg/mL, therapeutic range 10-20 mcg/mL). The mother and the patient were immediately separated, and she was replaced by another legal guardian. One week later, the neurological and other signs and symptoms were completely resolved. The child was placed under paternal custody with a court order and moved to another state. After that, the mother reported phenytoin use for her child and was referred to psychiatric follow-up. In conclusion, the first case of MBPS mimicking cSLE, resulting in multiple unnecessary examinations and treatments with delayed diagnosis was reported.
- Ocular Munchausen's Syndrome induced by introduction of ant's particles into the conjunctival fornices. [Journal Article]
- SJSaudi J Ophthalmol 2018 Oct-Dec; 32(4):353-354
- Munchausen's Syndrome is a factitious disorder in which patients manipulate physicians through misrepresented signs and symptoms. The authors describe an 18-year-old woman with self-induced inoculati…
Munchausen's Syndrome is a factitious disorder in which patients manipulate physicians through misrepresented signs and symptoms. The authors describe an 18-year-old woman with self-induced inoculation of ant's particles inside her conjunctival fornices of both eyes. The crushed particles was confirmed to be crushed ant's particles. Munchausen Syndrome can be seen with ophthalmic manifestations and should be considered in the differential diagnoses when ocular abnormalities cannot be explained. A sympathetic and supportive approach is therefore required and these patients should be urgently referred to a psychiatrist.
- Hypoglycemia secondary to factitious hyperinsulinism in a foster care adolescent - a case report of munchausen syndrome in a community hospital emergency department setting. [Journal Article]
- BEBMC Emerg Med 2018 12 11; 18(1):53
- CONCLUSIONS: Factitious disorder in the setting of recurrent hypoglycemia episodes may warrant a psychiatric referral and appropriate discharge follow-up to avoid multiple hospitalizations. Presentation in a non-diabetic patient from insulin use is a type of illness that is a challenge for emergency department physicians to appropriately diagnose and treat. Classic findings include a low blood sugar level, suppressed C-peptide level, and an inappropriately elevated insulin level. Recognizing these psychiatric presentations is crucial in order to stabilize patients and prevent unnecessary testing.
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- Cutaneous Munchausen Syndrome by Proxy: A Diagnostic Challenge for Dermatologist. [Case Reports]
- IDIndian Dermatol Online J 2018 Nov-Dec; 9(6):435-437
- Munchausen syndrome by proxy (MSBP) is a rare psychiatric disorder of a caregiver (commonly mother) who induces injury or symptoms on victim because of his or her psychiatry illness. The victims are …
Munchausen syndrome by proxy (MSBP) is a rare psychiatric disorder of a caregiver (commonly mother) who induces injury or symptoms on victim because of his or her psychiatry illness. The victims are usually under 6 years of age who cannot complain regarding inflicted injury. Diagnosis is challenging to the physician. We came across a 15-month-old girl child, who had consulted various specialists for episodes of blister followed by erosions on body since 6 months of age. Dermatological examination revealed blisters and healed leaf-shaped scars of different sizes which were suggestive of scalds. Smell of different varieties of oils, dribbling of hot oil from body at various intervals, and mother being the first to notice appearance of new skin lesions in all past episodes lead to suspicion of cutaneous MSBP with mother being the culprit. The family members were counselled regarding nature and course of the condition, mother was started on psychotropics, and the child was rescued from mother along with symptomatic treatment of the skin lesions.