Munchausen's syndrome. A case of factitious hemoptysis.

Factitious hemoptysis is the bleeding type of Munchausen's syndrome, rarely reported in the literature (only seventeen cases). After a careful and detailed literature review, the authors report the case of a 22-year-old working-woman, with a history of asthma, Mediterranean anaemia and recurrent hemoptysis, who was admitted several times to the cardiovascular and Respiratory Sciences Department in the Carlo Forlanini Hospital in 1994 for an asthmatic attack and wheeziness at rest. During the admissions the patient underwent laboratory tests (such as the examination of sputum specimens, urinalysis, tuberculin test, cold agglutinins and pneumotropic virus tests) and diagnostic studies (fiberoptic bronchoscopy with bronchoalveolar lavage, computerized tomography and radiography of the chest, bronchial arteriography, bronchography, perfusion and ventilation lung scan), because she continually presented with hemoptysis, in order to spot and discover the nature of the bleeding. Since such examinations failed (a few of them-namely fiberoptic bronchoscopies--were even performed when she was coughing up blood) and psychiatric consultations revealed the presence of psychologically traumatic events in the patient's history which could explain the psychopathic traits of her personality (in fact she was aggressive and unstable in interpersonal relations), a diagnosis of factitious hemoptysis in Munchausen's syndrome was made.

Pulmonary hamartoma. A rare case report.

Pulmonary hamartoma is a rare lung neoformation, usually symptomless and by chance discovered, of a probable dysontogenetic origin with prevailing cartilaginous tissue and adult, onset age. The Authors report a rare case of a 25-year-old student, symptomless and fortuitously found by means of a radiograph of the chest. Many interesting features characterize the case report: histological nature of the pulmonary hamartoma, mainly vascular, so much as to feign an angiosarcoma at the macroscopical examination, and with small peripheral calcifications as shown by lung CT scan; the measures (about 7 cm) plentifully above the parameters usually reported in the literature (from 2 cm to 4 cm); the young onset age (about 10 years old). We may consider a case exceptionally reported in the literature. Besides, on the base of a few studies and of our experience, the results of the pulmonary hamartoma growth rate and doubling time are reported.

[Hepato-splenic and peritoneal tuberculosis. A difficult diagnosis]. / La tubercolosi epato-splenica e peritoneale. Una diagnosi non agevole.

Peritoneal tuberculosis is a rare extra-pulmonary location of Mycobacterium tuberculosis infection arising in the gastrointestinal tract mostly as a complication of the pulmonary location or seldom as a primary involvement. The authors report the case of a 18-year old girl admitted in 1996 to the Infectious Diseases Department of the Umberto I Hospital, "La Sapienza" State University of Rome for the persistence of fever and dry cough, despite a protracted antibiotic treatment performed in previous hospital admissions for a suspicious diagnosis of a "broncho-pneumonia". As the fever didn't decrease and a pain at the right ilium arose, an anti-tuberculous chemotherapeutic treatment was performed (isoniazid and rifampicin), that improved the state of the patient. The pain was resolved by means of a celioscopic operation, showing the evidence of various white nodes on the peritoneal, hepatic and lienal surfaces; all these pathognomonic signs and the anti-tuberculous chemotherapy confirmed the diagnosis of "hepatic, lienal and peritoneal tuberculosis". The patient was subsequently admitted to our institute, where an anti-tuberculous treatment (isoniazid, rifampicin and pyrazinamide) was performed, which caused a further resolution of the clinical and radiological picture.