Obesity as a Presentation of Munchausen Syndrome by Proxy.

Objective: To describe a case of an obese child whose weight gain was related to the Munchausen Syndrome by proxy (MSP). Methods: This is a case report including information regarding the child's clinical history and the mother's behavior. The common features of the syndrome are confronted with the description of the case, seeking to demonstrate the similarities. Results: The description ratifies the diagnosis based on the signs and symptoms presented by the child (<5 years old, frequent contacts with health system, symptoms witnessed only by the mother, confusing findings, not helped by treatments, emotionally distant father) and the attitude of the mother (concerned, interested in procedures, comfortable in the medical setting, higher medical knowledge, hostile when thwarted). Conclusion: The case presented points to a new etiology, the MSP, to be considered within the set of factors currently known to cause and maintain obesity in childhood.

Munchausen syndrome by proxy mimicking as Gaucher disease.

Although rare, Munchausen syndrome by proxy (MBP) is a potentially life-threatening form of child abuse. Here, we report a 19-month-old female infant who presented with hepatosplenomegaly, anemia, thrombocytopenia, and recurrent septicemia. She was initially thought to have myelodysplastic syndrome. Further hematological and immunological investigations revealed no cause. beta-Glucosylceramidase enzyme activity on dried blood spot was suggestive of Gaucher disease. However, the enzyme level on cultured skin fibroblast was not consistent with Gaucher disease. The first hint about MBP was the recurrent sepsis with numerous gram negative rods. Furthermore, the mother's behavior and health history raised our suspicion about MBP. The child showed significant improvement after she was separated from the mother for a week. Finally, the mother confessed that she was spitting in local herbs and injecting it into the central line. This is, to our knowledge, the first report of MBP resembling in its presentation Gaucher disease. This case should alert the general and specialized pediatricians about MBP, as it may mimic metabolic diseases like Gaucher disease.

Anemia and neutropenic fever with high dose diazoxide treatment in a case with hyperinsulinism due to Munchausen by proxy.

BACKGROUND: The etiology of hyperinsulinemic hypoglycemia in adolescents is similar to that of adults. Patients resistant to medical treatment may undergo pancreatectomy. Diazoxide is the mainstay of medical treatment. Rarely bone marrow suppression is reported due to diazoxide. PATIENT: An adolescent with severe hyperinsulinemic hypoglycemia was referred for pancreatectomy after she was treated with high doses of diazoxide, octreotide and glucose. She developed anemia and febrile neutropenia in the course of diazoxide treatment that resolved with cessation of medication. The cause of the hyperinsulinemia proved to be classical Munchausen by proxy. CONCLUSION: This is the first report of bone marrow suppression involving erythroid series by diazoxide. Follow-up of blood count may be considered in patients on high dosages since anemia may be dose dependent. Munchausen by proxy poses a serious threat to children with significant morbidity and mortality. Awareness and a high index of suspicion in clinical settings with unusual causes are the mainstay for the diagnosis.

Munchausen by Proxy Syndrome Associated with Fecal Contamination: A Case Report. / Fekal Kontaminasyon ile Ortaya Çikan Munchausen by Proxy Sendromu: Bir Olgu Sunumu.

Factitious disorder imposed on another, also known as Munchausen Syndrome by Proxy (MSBP), is a serious form of child abuse that is difficult to diagnose. In general, signs and symptoms are fabricated or produced by the mother or the caregiver. Delay in diagnosis may cause serious morbidity and mortality. Here, we present the case of an 18-month-old boy who was admitted to the Paediatric Infection Clinic with a diagnosis of acute gastroenteritis. When on intravenous fluid therapy, he developed high fever and subsequently, polymicrobial growth was determined in his blood. He was later diagnosed with MSBP. Despite being a rare condition, MSBP is a disorder that is often overlooked and may have fatal outcomes. Early diagnosis is very important in this disorder, which is considerably difficult to diagnose. In suspected cases, interdisciplinary team work is necessary to prevent adverse consequences.

Unexplained destructive nasal lesions in half-brothers: A possible case of Munchausen syndrome by proxy.

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.

An 18-month-old girl with recurrent apneic spells.

We describe the case of an 18-month-old child with recurrent apneic episodes, often requiring resuscitation, who was admitted to an academic pediatric medical center after previous evaluations had been unrevealing.

Medical Child Abuse: A Case Presenting as Anogenital Bleeding of Unknown Origin in an Older Child.

BACKGROUND: Medical child abuse is a challenging diagnosis to make, particularly in older children with unusual presenting symptoms. CASE: A 7-year-old child with complex medical history presented with anogenital bleeding of unknown origin. Extensive laboratory testing, imaging studies, and diagnostic procedures were negative for any etiology. Forensic testing confirmed the blood in her underwear was a genetic match to the patient. Trial separation from the mother was diagnostic and therapeutic in this case. SUMMARY AND CONCLUSION: Older children who are victims of medical child abuse might present in a variety of ways, and might even collaborate with the perpetrator in falsifying symptoms. It is important to keep medical child abuse on the differential when the patient's symptoms and work-up do not match.

A case of Munchausen syndrome by proxy with subsequent stalking behavior.

A case of Munchausen syndrome by proxy (factitious disorder by proxy) wherein the patient presented with symptoms of severe borderline personality disorder and questionable psychotic symptoms is discussed. This patient was also adjudicated for harassing and stalking a child protective services worker assigned to her case. Issues pertaining to possible feigning of psychotic symptoms were addressed in her inpatient treatment. Despite doubts concerning the veracity of some of her psychotic symptoms, the patient responded well to clozapine, and she was subsequently able to stay out of the psychiatric hospital for longer periods and make a reasonably good adjustment to living in a group home. After refusing to continue with clozapine therapy because of weight gain concerns, her adjustment declined.

Munchausen syndrome by proxy: unusual manifestations and disturbing sequelae.

Since the initial description of Munchausen Syndrome by Proxy (MSBP) (Meadow, 1977), numerous cases have been reported varying from as simple as the complaint of a nonexistent symptom to those as complicated as altered laboratory tests leading to the false diagnosis of cystic fibrosis (Orenstein & Wasserman, 1986; Rosenberg, 1987). We report three findings previously unreported: esophageal perforation, retrograde intussusception, and tooth loss. Bradycardia has been previously reported associated with suffocation (Meadow, 1984), but in our case may have been caused by carotid artery massage. We also suggest possible induction by the mother of premature rupture of fetal membrane leading to delivery of infected infants.

Beyond collusion: active illness falsification.

OBJECTIVE: This article explores the relationship between factitious disorder by proxy victimization and the genesis of factitious disorder in young people. It is hoped that this will aid in our understanding of how some illness falsification behaviors may be learned and transmitted within the family system. METHOD: A discussion of the origins of adult factitious disorder and recent findings on the phenomenon of illness falsification in children and adolescents is integrated with some of the more ambiguous or "blended" cases which combine primary falsification by the youngster with caregiver collusion. Those less easily classified cases of factitious illness which fall in the gray areas, containing elements of both independent illness falsification by a child or adolescent with an earlier history of collusion with a parent's Munchausen by Proxy disorder, are proposed as a type of transitional case which may help us better understand the process by which illness falsification is learned. RESULTS: The literature on illness falsification in adults supports the possibility that adult factitious disorder may have its origins in adolescence or perhaps even earlier. Several cases are identified which suggest that some youngsters independently falsifying illness may have had earlier experiences of Munchausen by Proxy victimization or perhaps experienced the modeling or encouragement of illness falsification by a caregiver. Certain elements of the child victim experience, including efforts to overcome feelings of powerlessness, chronic lack of control, and disappointment in the physician are suggested as possible dynamics in the eventual development of independent illness falsification behaviors. CONCLUSIONS: The many unanswered questions in our understanding of the development of factitious illness in children and adolescents suggest avenues for further research. It is hoped that increased understanding will eventually allow more rapid, reliable identification of these patients and more effective interventions within the family system, with positive implications for future generations.

Munchausen syndrome by proxy: neurological manifestations.

Munchausen syndrome by proxy (MSP) is a recently described form of child abuse in which a caregiver fabricates or induces symptoms in a child in order to attract medical attention. The epidemiology, clinical features, diagnosis and the spectrum of MSP are reviewed. Central nervous system symptoms are a common presentation of MSP because they can be reported without confirmation. Three cases are reported to illustrate the most common neurological manifestations. It is important for neuroscience nurses to have an awareness that MSP can present as a neurologic problem, because appropriate management depends on early identification and treatment.

[A child with puzzling complaints--does he have a disease?]. / Een kind met onbegrepen klachten--heeft het wel een ziekte?

Two children were presented to the physician with serious, long-lasting and unexplained complaints. The first was a girl aged four years with diarrhoea, vomiting and subfebrile temperature, the other was a boy aged almost 1 year with sudden spells of cyanosis and tachycardia. The mothers were found to falsify and fabricate the illness of their children: Münchausen syndrome by proxy. As a consequence of this behaviour, the children underwent extensive and sometimes invasive diagnostic investigations and treatment for their puzzling illness. A number of alarm signals associated with the condition, the parent and the child may help the physician to recognize and diagnose this syndrome at an early stage. Confrontation of the mother with the incriminating findings must take place under carefully prepared circumstances. The syndrome is related to the mothers' need for medical attention in order to retain a certain psychological balance. The fathers often have a passive role in the family life.

[Munchausen syndrome by proxy: report of one case with epilepsy]. / Síndrome de Munchausen por poderes: presentación de un caso con epilepsia.

INTRODUCTION: Munchausen syndrome by proxy (MSBP) is a rare form of child abuse in which a parent, usually the mother, fabricates or produces illness in a child, so causing them unnecessary medical investigations, treatments and hospitalizations. One of the commonest false presenting symptom is 'seizures'. CLINICAL CASE: An eight years old boy with Munchausen syndrome by proxy is reported. This child had had genuine seizures well controlled by standard anticonvulsant treatment at the start of the false illness. At the age of seven years, the patient showed very frequent seizures. The child was treated with antiepileptic drugs, but treatments were ineffective and seizures continued. Results of multiple tests, including an extensive blood chemistry analyses, CT, MRI, SPECT, were normal. Electroencephalogram showed posterior slow waves. Acute neurological deterioration was observed six weeks after hospitalization and it was finally proved that seizures were caused or triggered by clomipramine poisoning given by her mother. CONCLUSIONS: MSBP frequently presents as epileptic seizures in these abused children. MSBP diagnosis is more difficult to be made if true seizures exists with multiple fictitious seizures. Pediatrician should be alerted to the possibility of MSBP when seizures are poorly controlled, treatments are ineffective and there is no neurophysiologic dysfunction. Early diagnosis and intervention are essential because high mortality and psychologic morbidity are associated with this syndrome.

[A case of Munchausen syndrome by proxy with digestive symptoms and severe growth retardation]. / Su un caso di sindrome di Munchausen per procura con sintomi digestivi e grave ritardo di crescita.

A case of Munchausen syndrome by proxy in an infant presenting with recurrent vomiting and severe failure to thrive is described. Only very few cases of this syndrome have been reported in the italian literature in comparison to those described in the Anglo-Saxon countries. The factitious symptoms and signs fabricated or induced by parents lead to unnecessary medical investigation, hospital admissions and treatment. The Authors emphasize the difficulties in reaching a diagnosis and the risks of this potentially very dangerous behaviour in terms of morbidity and mortality. Since only one third of parents recover following psychotherapy, the offending parent should be sometimes separated from the child and promptly reported and closely supervised by the legal Authorities. Bizarre and otherwise peculiar, unexplained symptoms should always suggest the possibility of the Munchausen syndrome by proxy.

Munchausen syndrome by proxy presented as recurrent respiratory arrest and thigh abscess: a case study and overview.

While many physicians are familiar with the sexual or physical abuse of children, there is little awareness about Munchausen syndrome by proxy (MSBP). As case reports of MSBP increase, awareness among physicians is thought to increase as well. We thus present herein a 16-month-old girl who admitted to Hacettepe University Ihsan Dogramaci Children's Hospital with the complaint of seizure, recurrent apnea and thigh abscess, who was later diagnosed as MSBP. The case was being followed by the Child Protection Team of the hospital (Haceteppe University Child Protection Unit [HU-CPU]). HU-CPU contributed to the early detection of this case and protected the child from a possible fatal outcome. The mother was confronted for MSBP and refused to take responsibility for her child's symptoms. As seen in this case, when MSBP is suspected, psychiatric evaluation of the mother, evaluation of the mother-child interaction and collection of a detailed family and social history can have a positive impact on the prognosis in these cases. This case report underlines the importance of multidisciplinary team work to share the responsibility and reduce the burden during the treatment process of these difficult and complicated cases.

Severe hypernatremia in a hospitalized child: munchausen by proxy.

An 8-week-old infant presented to a referring institution with profuse diarrhea and infectious enteritis for 1 week. He was initially treated for suspected Salmonella spp. sepsis and meningitis, because the organism was found in the stool, but the child's illness progressed, manifested by paroxysmal profuse diarrhea and increased urine output. After several weeks, he suffered a sagittal venous thrombosis and intracranial hemorrhage. Subsequently the child was transferred to a tertiary center for intestinal evaluation. The patient's diarrhea and excessive diuresis resolved, and his sodium normalized soon after transfer. Four days later, however, after his mother arrived, he immediately developed severe hypernatremia (serum sodium concentration [Na(+)] = 214 mEq/L), with resumption of diarrhea and excessive diuresis. A gastric aspirate during the crisis demonstrated an extremely high sodium content, [Na(+)] = 1416 mEq/L, consistent with salt intoxication. Surveillance of the mother revealed that she manipulated the indwelling nasogastric tube; confronted, she admitted to salt administration. This case describes one of the ways that Munchausen syndrome by proxy can manifest with profound neurologic sequelae, and highlights the need for close observation and swift intervention when sufficient cause is present.