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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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Hassona Y. Self-provoked oral illness: When the mouth mirrors the soul. SPECIAL CARE IN DENTISTRY 2024; 44:756-760. [PMID: 37803823 DOI: 10.1111/scd.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/07/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Factitious disorder imposed on self (FDIS), also known as Munchausen's syndrome, is a psychological disorder characterized by falsification of physical or psychological symptoms without an obvious external incentive. Oral presentations of FDIS are infrequently reported, and diagnosis might be challenging because affected patients often have impressive skills in fabricating symptoms and deceiving healthcare professionals. AIM To describe the diagnostic dilemma and management challenges in a female patient who presented with tooth ache and oral ulcers. CASE DESCRIPTION A 53-year-old female presented with complex medical history, vague symptoms and confusing dental history regarding persistent toothache and generalized oral ulcers. She underwent extensive investigations and multiple dental and oral surgical procedures without reaching a confirmed diagnosis or achieving symptomatic improvement. Thorough review of her medical records revealed multiple admissions to various hospitals across the country and abroad for various reasons, and failed to find any laboratory, clinical, or radiographic evidence of her "claimed" symptoms. CONCLUSION Oral healthcare professionals should suspect FDIS in patients presenting with vague and complex history that is not explained by clinical or radiographic findings. Consultation with psychiatric department and hospital administration might be needed to confirm diagnosis and plan appropriate management of the case.
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Affiliation(s)
- Yazan Hassona
- Faculty of Dentistry, Amman Al Ahliyya University, Amman, Jordan
- Oral Medicine and Special Care Dentistry, School of Dentistry, The University of Jordan, Amman Queen Rania Street, Amman, Jordan
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3
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Spinnato P, Masuzzo O, Tuè G, Tucci F, Papalexis N, Miceli M. Suspected Diagnosis of Munchausen's Syndrome: Awareness for the Radiology Community. Acad Radiol 2024; 31:1719-1720. [PMID: 38216414 DOI: 10.1016/j.acra.2023.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/31/2023] [Accepted: 12/31/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Oriana Masuzzo
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giovanni Tuè
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Tucci
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicolas Papalexis
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Stratopoulos E, Leonardou A, Pitsios C. Hymenoptera Venom Immunotherapy Meets Factitious Disorder. Cureus 2024; 16:e55769. [PMID: 38586777 PMCID: PMC10998981 DOI: 10.7759/cureus.55769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Factitious disorder on self is a psychiatric disorder in which individuals fabricate or induce signs or symptoms of a disease. Factitious anaphylaxis, with symptoms suggestive of a life-threatening allergic reaction, is extremely rare. Several cases of factitious disorder reactions during allergen immunotherapy for airborne allergens have been reported. We report the case of a young female patient who presented factitious anaphylaxis during venom immunotherapy to vespid venom extract. Symptoms of stridor, dyspnea, coughing and loss of consciousness were observed during the built-up phase of venom immunotherapy, mimicking allergic reactions to the venom extracts. Diagnosis of factitious disorder prompted the discontinuation of venom immunotherapy.
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Affiliation(s)
| | - Angeliki Leonardou
- Psychiatry, Women's Mental Health Clinic, National and Kapodistrian University of Athens, Athens, GRC
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Ray TR, Kellogg RT, Fargen KM, Hui F, Vargas J. The perils and promises of generative artificial intelligence in neurointerventional surgery. J Neurointerv Surg 2023; 16:4-7. [PMID: 37438101 DOI: 10.1136/jnis-2023-020353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
Generative artificial intelligence (AI) holds great promise in neurointerventional surgery by providing clinicians with powerful tools for improving surgical precision, accuracy of diagnoses, and treatment planning. However, potential perils include biases or inaccuracies in the data used to train the algorithms, over-reliance on generative AI without human oversight, patient privacy concerns, and ethical implications of using AI in medical decision-making. Careful regulation and oversight are needed to ensure that the promises of generative AI in neurointerventional surgery are realized while minimizing its potential perils.[ChatGPT authored summary using the prompt "In one paragraph summarize the promises and perils of generative AI in neurointerventional surgery".].
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Affiliation(s)
- Tyler R Ray
- Department of Mechanical Engineering, University of Hawaii at Mānoa College of Engineering, Honolulu, Hawaii, USA
| | - Ryan T Kellogg
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kyle M Fargen
- Department of Neurological Surgery and Radiology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ferdinand Hui
- Neurointerventional Surgery, Queen's Medical Center Neuroscience Institute, Honolulu, Hawaii, USA
| | - Jan Vargas
- Division of Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
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Alkhattabi F, Bamogaddam I, Alsagheir A, Al-Ashwal A, Alhuthil R. Munchausen syndrome by proxy: a case report. J Med Case Rep 2023; 17:148. [PMID: 37013583 PMCID: PMC10071623 DOI: 10.1186/s13256-023-03848-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Inappropriately high levels of insulin secretion can cause the potentially fatal condition of persistent hyperinsulinemic hypoglycemia of infancy. Our paper focuses on another cause of severe hypoglycemia, which can be easily missed. CASE PRESENTATION An 18-month-old Saudi female was referred to our hospital for further investigation and management of her recurrent hypoglycemic attacks as a case of persistent hyperinsulinemic hypoglycemia of infancy. During admission, we noticed multiple red flags from the history; the mother was insisting on a pancreatectomy, rather than going for a positron emission tomography scan, and most importantly, all hypoglycemic attacks occurred while the mother was around. Consequently, after further investigation, the case was diagnosed as a caregiver-fabricated illness, and the case was referred to the Child Protection Center. CONCLUSIONS One must have a high index of suspicion to diagnose caregiver-fabricated illness. Physicians should be more attentive to prevent such a disease, which could eventually become lethal if left unnoticed.
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Affiliation(s)
- Fadiah Alkhattabi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh, 11211, Saudi Arabia.
| | - Israa Bamogaddam
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh, 11211, Saudi Arabia
| | - Afaf Alsagheir
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh, 11211, Saudi Arabia
| | - Abdullah Al-Ashwal
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh, 11211, Saudi Arabia
| | - Raghad Alhuthil
- Department of Pediatrics, King Faisal Specialist Hospital and Research Centre, Al Takhassousi & 12713, Riyadh, 11211, Saudi Arabia
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Munchausen by Proxy: Quem e Como? Uma Revisão da Literatura. REVISTA PORTUGUESA DE PSIQUIATRIA E SAÚDE MENTAL 2023. [DOI: 10.51338/rppsm.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
A síndrome de Munchausen by proxy resulta numa forma de abuso infantil relativamente rara, que acarreta importantes consequências a curto, médio e longo prazo nas vítimas, geralmente crianças. O abusador, frequentemente a mãe da vítima, sem pretensão de ganhos secundários, exagera, fabrica, simula ou induz, de forma deliberada e persistente, sinais e sintomas na criança, levando os profissionais de saúde a acreditarem estar perante alguma patologia real, seguindo uma marcha diagnóstica infrutífera. Pouco se sabe sobre as características dos perpetradores, nomeadamente no que diz respeito à sua história pessoal, antecedentes psiquiátricos e características sociodemográficas, já que a grande maioria dos dados disponíveis na literatura incide apenas nas características das vítimas. Sendo um diagnóstico que levanta diferentes desafios, e provavelmente com prevalência subestimada, esta revisão da literatura debruça‐se sobre o perfil dos agressores, pretendendo consciencializar e auxiliar os profissionais de saúde na sua correta identificação, tão precoce quanto possível.
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Yoshida K. Etiology of Pneumoparotid: A Systematic Review. J Clin Med 2022; 12:jcm12010144. [PMID: 36614949 PMCID: PMC9821654 DOI: 10.3390/jcm12010144] [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] [Received: 11/04/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Pneumoparotid describes retrogradely insufflated air within the Stensen's duct and/or parotid gland. It is a rare condition with variable causative factors. This study aimed to elucidate the clinical characteristics of pneumoparotid. Reports in all languages were evaluated following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2020. A literature search was conducted using electronic medical databases (PubMed, Scopus, Web of Science, EBSCO, Ovid, Google Scholar, SciElo, LILIACS, and others) from 1890 to 30 June 2022. One hundred and seventy patients (mean age; 28.4 years) from 126 studies were reviewed. Common symptoms included swelling (84.7%) and pain (35.9%). Characteristic findings were crepitus in the parotid region (40%) and frothy saliva from the orifice (39.4%). The common etiologies included abnormal habits such as blowing out the cheeks (23.5%), idiopathic (20%), self-induced (15.9%), playing wind instruments such as trumpets or flutes (8.8%), and diseases inducing coughing or sneezing (8.2%). The treatments included antibiotic therapy (30%), behavioral therapy to avoid continuing causative habits (25.9%), psychiatric therapy (8.2%), and surgical procedures (8.2%). Treatment should be individualized and etiology-based. However, the etiology was not identified in 20% of patients. Further detailed data from larger samples are required to clarify and improve the recognition of this entity.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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9
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Knowledge and Attitudes of Medical and Nursing Students in Greece Regarding Child Abuse and Neglect. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121978. [PMID: 36553420 PMCID: PMC9777413 DOI: 10.3390/children9121978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Data on the knowledge and attitudes of healthcare practitioners in training regarding child abuse and neglect (CAN) are scarce. The aim of this study was to investigate the knowledge and attitudes regarding CAN of medical and nursing students in Greek universities. We performed a questionnaire-based e-survey on a convenience sample of students and recruited 609 students (366 medical and 243 nursing). An unsatisfactory level of knowledge in the field was reported overall. Most of the students (92.2%) were aware of their future responsibility to protect vulnerable children and report suspected cases of CAN; at the same time, they were willing to obtain further education. Based on the above, appropriate training in the undergraduate curriculum should be developed in order to strengthen future healthcare practitioners and boost their confidence in dealing with suspected cases of CAN and protect children's welfare.
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Razzak AN, Orlando NA, Angelette A, Kumar V, Anderson DJ, Hasoon J, Viswanath O, Kaye AD, Fitz-Gerald JS, Khater N, Urits I. Rare Mental Health Disorders Affecting Urologic Care: A Comprehensive Review. Health Psychol Res 2022; 10:38674. [PMID: 36628123 PMCID: PMC9820860 DOI: 10.52965/001c.38674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Management of mental health illnesses and needs are important in fostering psychosocial support, interprofessional coordination, and greater adherence to treatment protocols in the field of urology. This can be especially true for mental health conditions that may greatly impact the presentation of a patient in the healthcare setting with urologic symptoms. This review describes the history, epidemiology, pathophysiology, clinical presentation, and treatment of somatic symptom disorder, illness anxiety disorder, compulsive sexual behavior/hypersexuality, factitious disorder, malingering symptoms, and conversion disorder in the realm of urology. Given the newly updated psychiatric diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, there has been a lack of studies reviewing how these illnesses may present in a urology patient encounter. Additionally, as these mental health illnesses may carry a rare incidence compared to other well-known mental health illness such as generalized depression or generalized anxiety disorder, we have found that the lack of provisions and recognition of the diseases can prolong the timeline for diagnosis and lead to an increased cost in both healthcare and quality of life of patients with these mental health illnesses. This review provides awareness on these mental health conditions which may greatly impact patient history and presentation within the field of urology. Additionally, urologic care providers may have an improved understanding of interdisciplinary management of such illnesses and the common symptoms patients may present with such diseases.
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Affiliation(s)
| | | | | | - Vinay Kumar
- Department of PathologyUniversity of California Irvine
| | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain MedicineBeth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Valley Anesthesiology and Pain Consultants, Envision Physician Services; Department of Anesthesiology, University of Arizona College of Medicine; Department of Anesthesiology, Creighton University School of Medicine
| | - Alan D. Kaye
- Department of AnesthesiologyLouisiana State University Health
| | | | - Nazih Khater
- Department of UrologyLouisiana State University Health
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Anesthesiology, Louisiana State University Health Shreveport
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11
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Campos RT, Martiniano LVM, Lirio AKS, Souza KEDA, Rose N, Dias JMM, Cardoso ACA, Farhat SC, Silva CA. Nonsexual violence against children and adolescents: a study in a Latin American tertiary and university hospital. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2022; 40:e2021101. [PMID: 35544904 PMCID: PMC9095060 DOI: 10.1590/1984-0462/2022/40/2021101in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/08/2021] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The objective of this study was to assess interpersonal nonsexual violence against children and adolescents in a tertiary university hospital. METHODS A cross-sectional study was performed in 240 patients under nonsexual violence situation for 15 consecutive years. Data analyses included demographic data, hospital referral site, type and author of nonsexual violence, legal referral, laboratorial and imaging examinations, and outcomes. RESULTS Nonsexual violence situation was diagnosed in 240 (0.1%) of 295,993 patients for 15 years: 148 (61.7%) in children and 92 (38.3%) in adolescents. Out of 240, the most frequent types of violence were negligence in 156 (65.0%), physical 62 (25.8%), psychological/emotional aggression 52 (21.7%), Munchausen by proxy syndrome 4 (1.7%), and bullying/cyberbullying in 3 (1.3%). Out of 123, the most common pediatric chronic conditions were chronic kidney disease 24 (19.5%), human immunodeficiency virus 14 (11.4%), prematurity 9 (7.3%), cerebral palsy 8 (6.5%), and asthma 8 (6.5%). Further comparison between children versus adolescent under nonsexual violence situation revealed significant difference between the hospital referral sites. The frequency of patients under violence referred from outpatient clinics was significantly reduced in children versus adolescents (27.7 vs. 62%), whereas emergency department was higher in the former group (57.4 vs. 25.0%; p<0.001). All types of violence situations and pediatric chronic conditions were similar in both groups (p>0.05). CONCLUSIONS Nonsexual violence against our pediatric population was rarely diagnosed in a tertiary hospital, mainly negligence, physical, and psychological/emotional aggression. Approximately two-thirds of violence diagnosis occurred in children, referred mainly by the emergency department. In contrast, approximately one-third of violence diagnosis occurred in adolescents, referred mostly by outpatient clinics.
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Affiliation(s)
| | | | | | | | - Natalia Rose
- Universidade de São Paulo, São Paulo, SP, Brazil
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12
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Loke KY, Ng NBH, Sng AA, Teo YM, Lin JB. An unexpected revelation in a child with recurrent severe headaches. J Paediatr Child Health 2021; 57:1510-1512. [PMID: 33185948 DOI: 10.1111/jpc.15261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kah Yin Loke
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Nicholas Beng Hui Ng
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Andrew A Sng
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Yi-Ming Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore.,Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jeremy B Lin
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
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Yukina M, Nuralieva N, Troshina E, Malysheva N, Zuraeva Z, Bratchikova A. Clinical Case of Surreptitious Hypoglycemia Due to Deliberate Insulin Analog Administration. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 14:11795476211009234. [PMID: 33958903 PMCID: PMC8064658 DOI: 10.1177/11795476211009234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
Hypoglycemic syndrome is a life-threatening condition that can lead to hypoglycemic coma and death. Surreptitious hypoglycemic syndrome is the deliberate use of insulin preparations or oral hypoglycemic drugs aimed to reduce blood glucose level. If human insulin is injected, high level of immunoreactive insulin (IRI) and low level of C-peptide at the moment of hypoglycemia are always detected. However, the fact of deliberate administration of insulin analogs is difficult to prove. In these cases if insulin kit test with low cross-reactivity with insulin analogs is used, the low levels of IRI and C-peptide will be suspected. Some experts suggest the presence of cross reactivity with analogs of insulin in a number of commercial kits, which makes it possible to detect cases of surreptitious hypoglycemia. We present a clinical case of a patient with surreptitious hypoglycemia due to the administration of insulin analogs and discuss the problems of its laboratory diagnosis.
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Adhikari TR, Dorji T. Recurrent ear bleed with profound bilateral sensorineural hearing loss: A case of Munchausen syndrome. SAGE Open Med Case Rep 2021; 9:2050313X211000869. [PMID: 33786189 PMCID: PMC7958153 DOI: 10.1177/2050313x211000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Factitious disorders and Munchausen syndromes present with history and physical symptoms
to all specialties, and they are often extensively evaluated. Diagnosis of Munchausen
syndrome is a challenge and patients often do not receive the correct diagnosis and
appropriate care especially in settings where access to mental health professionals is
difficult. We present a case of recurrent bleed from the right ear, bilateral profound
hearing loss and jerky movement of limbs that was extensively evaluated and followed up
for 4 years until a diagnosis of Munchausen syndrome was reached. This case reports the
risk of harm to the patient and wastage of healthcare resources unless physicians begin to
actively evaluate for factitious disorders.
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Affiliation(s)
- Tika Ram Adhikari
- Department of ENT and Head and Neck Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Thinley Dorji
- Department of Internal Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.,Kidu Mobile Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
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15
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Domosh RA. Child Maltreatment in Medically Fragile Children. J Pediatr Nurs 2021; 57:106-110. [PMID: 33526288 DOI: 10.1016/j.pedn.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Franco JOB, Batistão RS, Santos DC, Ferreira WFS, Vasconcelos CR. Bioética e sociedade. REVISTA LATINOAMERICANA DE BIOÉTICA 2020. [DOI: 10.18359/rlbi.3565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetiva-se compreender a síndrome de Münchhausen a partir da descrição das suas causas, dos critérios de identificação, dos sinais clínicos, do diagnóstico e do tratamento, bem como das assistências realizadas pela Enfermagem e pela equipe interdisciplinar com interface da Bioética. Trata-se de uma revisão narrativa de literatura de caráter exploratório reflexivo, com abordagem qualitativa. Realizaram-se buscas de estudos em periódicos publicados entre 2009 e 2019; a amostra final constituiu-se por 30 artigos, além de livros, manuais e normativas. Os resultados apresentados evidenciam o conhecimento da quinta edição do Manual Diagnóstico e Estatístico de Transtornos Mentais, no qual a expressão “síndrome de Münchhausen imposto a si próprio” foi substituída por “transtorno factício autoimposto”, e a “síndrome de Münchhausen por procuração” foi alterada para “transtorno factício imposto a outro”, quanto à bioética. Indivíduos com o distúrbio factício tendem a buscar tratamento para si mesmo ou para outro. O comportamento desses pacientes aumenta a probabilidade de terem realmente uma doença física e até mesmo ir a óbito, causado pelo excesso de uso de medicações e pelos diversos procedimentos invasivos. Portanto, conclui-se que identificar o quadro clínico pode ser uma das primeiras iniciativas para a detecção e a prevenção. O tratamento deve se concentrar no manejo, com a possibilidade do uso da psicoterapia e de antidepressivos, antipsicóticos e ansiolíticos. A equipe de enfermagem e a multiprofissional devem estar atentas a sinais e sintomas para uma intervenção precisa e precoce, pois desempenham importante papel na identificação adequada do diagnóstico.
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Kobusiak-Prokopowicz M, Marciniak A, Tokarczyk B, Kała M, Leszek J, Mysiak A. Münchausen Syndrome as an Unusual Cause of Pseudo-resistant Hypertension: A Case Report. Open Med (Wars) 2019; 14:792-796. [PMID: 31737783 PMCID: PMC6843548 DOI: 10.1515/med-2019-0094] [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] [Received: 05/12/2019] [Accepted: 09/18/2019] [Indexed: 12/02/2022] Open
Abstract
Münchausen syndrome can be characterized by simulated illness, pathological lying and wandering from place to place (the patient typically presents to numerous hospitals). Individuals with elevated blood pressure due to non-adherence to medication have the so-called pseudo-resistant hypertension. A 45-year-old woman was admitted to hospital on an emergency basis because of a hypertensive crisis. Despite combination antihypertensive treatment, normalization of blood pressure was not achieved and a device to produce a therapeutic arteriovenous fi stula was implanted. Aft er the procedure, a signifi cant increase in pulmonary artery pressure was observed and closure of the fistula was performed by implantation of the stent graft . The suspicion was raised that the patient had not been taking her prescribed medications. Therefore, blood samples were taken and the serum was analyzed for presence of the prescribed drugs (atorvastatin, bisoprolol, chlorthalidone, clonidine, doxazosin, furosemide, nitrendipine, oxazepam and valsartan). The results confirmed suspected failure of the patient to take the prescribed medications. Münchausen syndrome is usually first suspected when inexplicable laboratory test results are noted. To our knowledge, this is the first reported case of Münchausen syndrome with pseudo-resistant hypertension leading to the implantation of a device to produce a therapeutic arteriovenous fi stula.
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Affiliation(s)
| | - Anna Marciniak
- Cardiology Department, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | | | - Maria Kała
- Institute of Forensic Research, 31-033 Krakow, Poland
| | - Jerzy Leszek
- Psychiatry Department, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Andrzej Mysiak
- Cardiology Department, Wroclaw Medical University, 50-367 Wroclaw, Poland
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Di Lorenzo R, Lannocca L, Burattini M, Vasta A, Galletti M, Minarini A, Mongelli F, Sportiello S, Rovesti S, Ferri P. Early death in Munchausen syndrome: A case report. Clin Case Rep 2019; 7:1473-1477. [PMID: 31428370 PMCID: PMC6692973 DOI: 10.1002/ccr3.2254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/04/2019] [Accepted: 05/19/2019] [Indexed: 12/30/2022] Open
Abstract
This case contributes to raising awareness and understanding of the complex clinical presentations of Munchausen syndrome (MS). Education of staff to the seriousness and genuineness of this disorder should be implemented, especially in hospital units, in order to detect such complex clinical situations quickly and accurately, preventing iatrogenic risks.
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Affiliation(s)
- Rosaria Di Lorenzo
- Department of Mental Health and Drug Abuse, Psychiatric Intensive Treatment FacilityAUSL ModenaModenaItaly
| | | | | | - Andrea Vasta
- Department of Mental Health and Drug AbuseAUSL ModenaModenaItaly
| | - Martina Galletti
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Alessandro Minarini
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Francesca Mongelli
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | | | - Sergio Rovesti
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Paola Ferri
- Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
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Pereira AV, Molina-Bastos CG, Gonçalves MR, Goulart BNGD. Factitious Disorder and the Interdisciplinary Team: identification of signs and risk factors. Codas 2019; 31:e20180173. [PMID: 30810614 DOI: 10.1590/2317-1782/20182018173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/25/2018] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Cynthia Goulart Molina-Bastos
- Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil.,Universidade Luterana do Brasil - ULBRA - Canoas (RS), Brasil
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Kuhne ACA, Pitta AC, Galassi SC, Gonçalves AMF, Cardoso ACA, Paz JA, Campos LMA, Silva CA. Munchausen by proxy syndrome mimicking childhood-onset systemic lupus erythematosus. Lupus 2019; 28:249-252. [PMID: 30616452 DOI: 10.1177/0961203318821156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- A C A Kuhne
- 1 Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - A C Pitta
- 1 Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - S C Galassi
- 2 Pediatric Inpatient Clinics, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - A M F Gonçalves
- 2 Pediatric Inpatient Clinics, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - A C A Cardoso
- 2 Pediatric Inpatient Clinics, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - J A Paz
- 3 Pediatric Neurology Unit, Children's Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - L M A Campos
- 1 Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - C A Silva
- 1 Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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