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Vahabi A, Daştan AE, Mirzazada J, Yoğun Y, Tezgel O, Aktuğlu K. Self-inflicted tourniquet application resulted with two fasciotomies: Case report of an initially omitted Munchausen case. Int J Surg Case Rep 2024; 119:109746. [PMID: 38728968 PMCID: PMC11101880 DOI: 10.1016/j.ijscr.2024.109746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Compartment syndrome is an emergency which requires prompt intervention. While main challenge typically revolves around determining necessity for fasciotomy in suspected cases, etiology is often pronounced, leaving little room for differential diagnosis. CASE REPORT We report a case with unconventional presentation and clinical course, ultimately diagnosed as Munchausen Syndrome. DISCUSSION It has been reported that individuals with Munchausen syndrome are successful at manipulating healthcare professionals. They often study the symptoms of their sickness, examination findings, and findings that may alert doctors, mastering their techniques over time. CONCLUSION It is of importance to consider Munchausen Syndrome as a potential cause, particularly in cases where clinical history and course of symptoms do not align with our experiences and cannot be reconciled with other possible diagnostic patterns.
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Affiliation(s)
- Arman Vahabi
- Ege University School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey.
| | - Ali Engin Daştan
- Ege University School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey
| | - Javad Mirzazada
- VM Medical Park Hospital, Department of Orthopedics and Traumatology, Kocaeli, Turkey
| | - Yener Yoğun
- Ankara University School of Medicine, Department of Orthopedics and Traumatology, Ankara, Turkey
| | - Okan Tezgel
- Van Educational and Research Hospital, Department of Orthopedics and Traumatology, Van, Turkey
| | - Kemal Aktuğlu
- Ege University School of Medicine, Department of Orthopedics and Traumatology, Izmir, Turkey
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Fabian E, Mayer G, Eller K, Pollheimer M, Queissner R, Krejs GJ. Clinical-Pathological Conference Series from the Medical University of Graz : Case No 178: A 30-year-old nurse with urine dipstick (+++)‑positive for protein in her late pregnancy. Wien Klin Wochenschr 2024; 136:298-304. [PMID: 38376552 PMCID: PMC11078789 DOI: 10.1007/s00508-023-02316-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Affiliation(s)
- Elisabeth Fabian
- Department of Internal Medicine II, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems on the Danube, Austria
| | - Gert Mayer
- Division of Nephrology and Hypertension, Department of Internal Medicine IV, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Eller
- Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Robert Queissner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Guenter J Krejs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
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Bérar A. [Factitious disorder imposed on self and Munchausen syndrome: An update]. Rev Med Interne 2024:S0248-8663(24)00094-8. [PMID: 38658265 DOI: 10.1016/j.revmed.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/21/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
Factitious disorder imposed on self (FDIS) is a mental disorder characterized by conscious manipulative behavior from patients with no clearly identifiable external objective. It affects subjects with a wide range of characteristics, only some of whom fit the stereotypical profile of the young female working in the health sector. It can take the form of a variety of symptoms or clinical signs, and is likely to involve all specialties. Munchausen syndrome is a particular form of FDIS, more prevalent in men and marked by its severity. Psychiatric comorbidities are common in patients with FDIS. Death is rare but possible, either as a result of the disease itself, complications of examinations or treatments, or suicide. The diagnostic approach must seek to identify positive arguments in favor of the disorder. Diagnosis by elimination remains possible when no other hypothesis can explain a clinical picture suggestive of FDIS. The prognosis is often poor, at least in the short and medium term. Avoiding unnecessary prescriptions is essential to prevent iatrogenesis. The management of FDIS is poorly codified. In all cases, the practitioner must adopt a non-aggressive, empathetic attitude.
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Affiliation(s)
- A Bérar
- Service de médecine légale et pénitentiaire, CHU Pontchaillou, 2, rue Henri Le Guilloux, 35033 Rennes, France; Université de Rennes, Rennes, France.
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Nombora O, Mendes E, Oliveira A, Ribeiro L. Munchausen Syndrome in the Context of Liaison Psychiatry: A Case Report and a Narrative Review. Cureus 2024; 16:e54289. [PMID: 38496112 PMCID: PMC10944582 DOI: 10.7759/cureus.54289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
Munchausen Syndrome (MS) has been widely recognized as a severe manifestation of factitious disorder, a condition where individuals intentionally fabricate or exaggerate symptoms for psychological gratification. It represents a complex diagnostic challenge due to its elusive nature and intricate relationship with various medical conditions. We present a clinical case of a 44-year-old woman observed in the context of Liaison Psychiatry, demonstrating the intricate interplay between chronic medical conditions, psychiatric factors, and the challenges in diagnosing and managing MS. The patient exhibited a history of recurrent hospitalizations, difficult-to-heal injuries, and a pronounced preference for surgical interventions. Despite diagnostic difficulties and poor therapeutic adherence, a multidisciplinary team approach involving plastic surgery, orthopedics, physical medicine, and rehabilitation, alongside Liaison Psychiatry, led to the diagnosis of MS with chronic osteomyelitis, ultimately necessitating a transtibial amputation. The case underscores the importance of early detection, a multidisciplinary approach, and the role of Liaison Psychiatry in managing MS. While early diagnosis may not alter the disease course, it can prevent unnecessary interventions and mitigate associated risks. The case also highlights the need for continuous psychiatric support and family involvement in addressing the recurrence of self-injurious behaviors. Further research is essential to enhance our understanding and develop effective treatment strategies for MS, contributing to improved diagnostic precision and overall management of this challenging psychiatric disorder.
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Affiliation(s)
- Odete Nombora
- Psychiatry Department, Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, PRT
| | - Eva Mendes
- Psychiatry Department, Liaison Psychiatry Unit, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, PRT
| | - André Oliveira
- Psychiatry Department, Liaison Psychiatry Unit, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, PRT
| | - Lúcia Ribeiro
- Psychiatry Department, Liaison Psychiatry Unit, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, PRT
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Bérar A, Bouzillé G, Jego P, Allain JS. A descriptive, retrospective case series of patients with factitious disorder imposed on self. BMC Psychiatry 2021; 21:588. [PMID: 34814866 PMCID: PMC8609835 DOI: 10.1186/s12888-021-03582-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. The present study aimed to explore factitious disorder imposed on self in a series of French patients. METHODS Patients 18 years old and over with factitious disorder imposed on self were retrospectively included by two independent reviewers according to DSM-5 criteria in Rennes University Hospital for the period 1995 to 2019. Patients were identified from a clinical data warehouse. RESULTS 49 patients with factitious disorder imposed on self were included. Among them, 36 (73.5%) were female. The average age at diagnosis was 38.4 years. The 16 patients with a health-related profession were all female. Direct evidence of falsification was found in 20.4% of cases. Falsification was mainly diagnosed on the basis of indirect arguments: history of factitious disorder diagnosed in another hospital (12.2%), extensive use of healthcare services (22.4%), investigations that were normal or inconclusive (69.4%), inconsistent or incomplete anamnesis and/or patient refusal to allow access to outside information sources (20.4%), atypical presentation (59.2%), evocative patient behaviour or comments (32.7%), and/or treatment failure (28.6%). Dermatology and neurology were the most frequently involved specialities (24.5%). Nine patients were hospitalized in intensive care. Some of them received invasive treatments, such as intubations, because of problems that were only reported or feigned. The diagnosis of factitious disorder imposed on self was discussed with the patient in 28 cases (57.1%). None of them admitted to making up the disorder intentionally. Two suicide attempts occurred within 3 months after the discussion of the diagnosis. No deaths were recorded. 44.9% of the patients returned to the same hospital at least once in relation to factitious disorder imposed on self. CONCLUSIONS The present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation.
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Affiliation(s)
- Antoine Bérar
- Univ Rennes 1, CHU Rennes, Service de Médecine Interne et Immunologie Clinique, 2 rue Henri Le Guilloux, 35 033, Rennes, France.
| | - Guillaume Bouzillé
- grid.410368.80000 0001 2191 9284Univ Rennes, CHU Rennes, INSERM, LTSI – UMR 1099, Rennes, France
| | - Patrick Jego
- grid.411154.40000 0001 2175 0984Univ Rennes 1, CHU Rennes, Service de Médecine Interne et Immunologie Clinique, Inserm, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France
| | - Jean-Sébastien Allain
- grid.411154.40000 0001 2175 0984CHU Rennes, Service de Médecine Interne et Immunologie Clinique, Inserm, CIC 1414, F-35000 Rennes, France ,grid.477854.d0000 0004 0639 4071CH Saint Malo, F-35400 Saint Malo, France
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Sinha A, Smolik T. Striving to Die: Medical, Legal, and Ethical Dilemmas Behind Factitious Disorder. Cureus 2021; 13:e13243. [PMID: 33585147 PMCID: PMC7872498 DOI: 10.7759/cureus.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Factitious disorder (FD) imposed on self is one of the most challenging and controversial problems in medicine. It is characterized by falsified medical or psychiatric symptoms where patients misrepresent, simulate, or cause symptoms of an illness in the absence of obvious tangible gains. Munchausen syndrome accounts for approximately 10% of all factitious illnesses and represents its most malignant form. An unknown number of deaths have likely occurred when considering that most cases go unrecognized and unreported. Here we describe a case in which the patient’s condition remained unrecognized, only being diagnosed months before her death from complications of FD. Psychiatry was consulted to see a 49-year-old Caucasian female regarding depression, poor oral intake, and her insistence on the placement of a feeding tube. The initial evaluation was negative for findings consistent with psychiatric illness. A review of records in our hospital was significant for one previous psychiatric inpatient stay eight months prior during which a diagnosis of FD imposed on self was made. Collateral information suggested a cycle of deception and simulation of illnesses with the patient’s daughter labeling her actions as “doctor shopping.” At our facility alone, she had accrued roughly 40 inpatient medical admissions and 70 ED visits in four years though only two encounters involving Psychiatry. A detailed chronological analysis of her records showed the only documented concern of deception to be that of an Internal Medicine resident two years prior. Psychiatry was not consulted despite this concern. During the present encounter, psychiatry recommended ethics consult, outpatient psychotherapy, and frequent follow-ups with primary care. A formal ethics consult was not completed before discharge. Within two months, the patient died at another facility. FD can lead to diagnostic and therapeutic procedures that result in irreversible morbidity and iatrogenic harm. Physicians in other medical specialties often suspect a patient of consciously deceiving others, though fail to assign psychiatric nomenclature due to lack of familiarity or comfort in making the diagnosis. This further substantiates the role of a multidisciplinary collaboration between medical, surgical, and psychiatry teams. Heightened awareness of, and suspicion for, Munchausen syndrome may improve rates of diagnosis and prognosis of these patients.
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Affiliation(s)
- Akriti Sinha
- Psychiatry, University of Missouri Health Care, Columbia, USA
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Hausteiner-Wiehle C, Hungerer S. Factitious Disorders in Everyday Clinical Practice. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:452-459. [PMID: 32897184 DOI: 10.3238/arztebl.2020.0452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/16/2019] [Accepted: 04/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The pathological feigning of disease can be seen in all medical disciplines. It is associated with variegated symptom presentations, self-inflicted injuries, forced but unnecessary interventions, unusual and protracted recoveries, and frequent changes of treating physician. Factitious illness is often difficult to distinguish from functional or dissociative disorders on the one hand, and from malingering on the other. Many cases, even fatal ones, probably go unrecognized. The suspicion that a patient's problem may be, at least in part, factitious is subject to a strong taboo and generally rests on supportive rather than conclusive evidence. The danger of misdiagnosis and inappropriate treatment is high. METHODS On the basis of a selective review of current literature, we summarize the phenomenology of factitious disorders and present concrete strategies for dealing with suspected factitious disorders. RESULTS Through the early recognition and assessment of clues and warning signs, the clinician will be able to judge whether a factitious disorder should be considered as a differential diagnosis, as a comorbid disturbance, or as the suspected main diagnosis. A stepwise, supportive confrontation of the patient with the facts, in which continued therapeutic contact is offered and no proofs or confessions are demanded, can help the patient set aside the sick role in favor of more functional objectives, while still saving face. In contrast, a tough confrontation without empathy may provoke even more elaborate manipulations or precipitate the abrupt discontinuation of care-seeking. CONCLUSION Even in the absence of systematic studies, which will probably remain difficult to carry out, it is clearly the case that feigned, falsified, and induced disorders are underappreciated and potentially dangerous differential diagnoses. If the entire treating team successfully maintains an alert, transparent, empathic, and coping-oriented therapeutic approach, the patient will, in the best case, be able to shed the pretense of disease. Above all, the timely recognition of the nature of the problem by the treating team can prevent further iatrogenic harm.
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Affiliation(s)
- Constanze Hausteiner-Wiehle
- Consultation-Liaison Psychosomatics, Neurocenter, BG Trauma Center, Murnau, and Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Klinikum rechts der Isar, Munich; Department of Arthroplasty, Consultation-Liaison Psychosomatics, Neurocenter, BG Trauma Center, Murnau, and Institute of Biomechanics, Paracelsus Medizinische Privatuniversität (PMU) Salzburg at BG Trauma Center, Murnau
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Carlier L, Rex S, Vanassche T, Verelst S, Desmet K, Van Elslande J, Verhamme P, Vandenbriele C. Münchhausen Syndrome: A Case Report of an Unusual Cause of Vitamin K Antagonist Intoxication. A A Pract 2020; 14:e01189. [DOI: 10.1213/xaa.0000000000001189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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9
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Dubiel R, Perzyński A, Kłębukowska I, Perzyńska-Starkiewicz A, Chmiel-Perzyńska I, Olajossy M. Can factitious disorder reach delusional level? A case study. CURRENT PROBLEMS OF PSYCHIATRY 2016. [DOI: 10.1515/cpp-2016-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The paper describes a patient, who has been consulted and hospitalized multiple times, due to dermatological lesions on his face. We will present his medical history and describe circumstances leading to the final diagnosis of factitious disorder. In the theoretical part we will try to answer the question, whether the extreme severity of the factitious disorders can, at some point, reach the level of delusions.
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Affiliation(s)
- Rafał Dubiel
- University Hospital No 1, Lublin, Poland , II Department of Psychiatry and Psychiatry Rehabilitation
| | - Adam Perzyński
- . Medical University, Lublin, Poland , II Department of Psychiatry and Psychiatry Rehabilitation
| | - Ida Kłębukowska
- University Hospital No 1, Lublin, Poland , II Department of Psychiatry and Psychiatry Rehabilitation
| | | | - Iwona Chmiel-Perzyńska
- Medical University, Lublin, Poland , Department of Experimental and Clinical Pharmacology
| | - Marcin Olajossy
- . Medical University, Lublin, Poland , II Department of Psychiatry and Psychiatry Rehabilitation
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Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry 2016; 41:20-8. [PMID: 27302720 DOI: 10.1016/j.genhosppsych.2016.05.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Patients with factitious disorder (FD) fabricate illness, injury or impairment for psychological reasons and, as a result, misapply medical resources. The demographic and clinical profile of these patients has yet to be described in a sufficiently large sample, which has prevented clinicians from adopting an evidence-based approach to FD. The present study aimed to address this issue through a systematic review of cases reported in the professional literature. METHOD A systematic search for case studies in the MEDLINE, Web of Science and EMBASE databases was conducted. A total of 4092 records were screened and 684 remaining papers were reviewed. A supplementary search was conducted via GoogleScholar, reference lists of eligible articles and key review papers. In total, 372 eligible studies yielded a sample of 455 cases. Information extracted included age, gender, reported occupation, comorbid psychopathology, presenting signs and symptoms, severity and factors leading to the diagnosis of FD. RESULTS A total of 66.2% of patients in our sample were female. Mean age at presentation was 34.2 years. A healthcare or laboratory profession was reported most frequently (N=122). A current or past diagnosis of depression was described more frequently than personality disorder in cases reporting psychiatric comorbidity (41.8% versus 16.5%) and more patients elected to self-induce illness or injury (58.7%) than simulate or falsely report it. Patients were most likely to present with endocrinological, cardiological and dermatological problems. Differences among specialties were observed on demographic factors, severity and factors leading to diagnosis of FD. CONCLUSIONS Based on the largest sample of patients with FD analyzed to date, our findings offer an important first step toward an evidence-based approach to the disorder. Future guidelines must be sensitive to differing methods used by specialists when diagnosing FD.
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Affiliation(s)
- Gregory P Yates
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Marc D Feldman
- Department of Psychiatry and Behavioral Medicine, University of Alabama, Tuscaloosa, AL, USA
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Chest Pain Suggestive of a Life-Threatening Condition: A Department of Medicine Morbidity and Mortality Conference. PSYCHOSOMATICS 2016; 57:89-96. [DOI: 10.1016/j.psym.2015.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 02/01/2023]
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Koufagued K, Chafry B, Benyass Y, Abissegue Y, Benchebba D, Bouabid S, Belkacem C. Munchausen syndrome revealed by subcutaneous limb emphysema: a case report. J Med Case Rep 2015; 9:172. [PMID: 26282124 PMCID: PMC4539713 DOI: 10.1186/s13256-015-0649-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 07/08/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction Limb subcutaneous emphysema secondary to a Munchausen syndrome represents a rare and severe entity because it involves the functional prognosis of the limb and vital prognosis of the patient. Case presentation We report the case of an 18-year-old Moroccan woman patient who presented to our hospital with a subcutaneous emphysema of the shoulder girdle and the right arm, caused by our patient. Treatment was aggressive, with a wide surgical debridement, parenteral antibiotic therapy and hyperbaric oxygen therapy. The results have been favorable. Conclusions The correlation of anamnestic data and clinical and para-clinical exams were essential for the diagnosis of Munchausen syndrome in this case. In this regard, we report a rare case of subcutaneous limb emphysema secondary to Munchausen syndrome.
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Affiliation(s)
- Kaldadak Koufagued
- Department of Orthopedic Trauma, Mohamed V Military Hospital, University Mohamed V- souissi Rabat Morocco, S/C ERSSM BP 1044, Rabat Océan, Morocco.
| | - Bouchaib Chafry
- Department of Orthopedic Trauma, Mohamed V Military Hospital, University Mohamed V- souissi Rabat Morocco, S/C ERSSM BP 1044, Rabat Océan, Morocco.
| | - Youssef Benyass
- Department of Orthopedic Trauma, Mohamed V Military Hospital, University Mohamed V- souissi Rabat Morocco, S/C ERSSM BP 1044, Rabat Océan, Morocco.
| | - Yves Abissegue
- Department of Orthopedic Trauma, Mohamed V Military Hospital, University Mohamed V- souissi Rabat Morocco, S/C ERSSM BP 1044, Rabat Océan, Morocco.
| | - Driss Benchebba
- Department of Orthopedic Trauma, Mohamed V Military Hospital, University Mohamed V- souissi Rabat Morocco, S/C ERSSM BP 1044, Rabat Océan, Morocco.
| | - Salim Bouabid
- Department of Orthopedic Trauma, Mohamed V Military Hospital, University Mohamed V- souissi Rabat Morocco, S/C ERSSM BP 1044, Rabat Océan, Morocco.
| | - Chagar Belkacem
- Department of Orthopedic Trauma, Mohamed V Military Hospital, University Mohamed V- souissi Rabat Morocco, S/C ERSSM BP 1044, Rabat Océan, Morocco.
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