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.

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.

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.

Entre la complancencia sanitaria y el trastorno facticio por poderes / No disponible

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El sindrome de Munchausen por poderes: un tipo especial de abuso infantil / Munchausen syndrome by proxy: a special type of child abuse

En el síndrome de Munchausen por poderes (SMpP), uno de los padres, en el 95% de los casos, la propia madre, inventa, falsifica y fabrica síntomas clínicos en su hijo hasta convertirle, de cara a los médicos y pediatras, en un enfermo. La última Clasificación de Enfermedades Mentales (DSM-5), ha introducido en el capítulo de Trastornos Adictivos el Trastorno por juego, abriendo la posibilidad de incorporar otras conductas problemáticas de riesgo adictivo que no se refieren a sustancias, como son los videojuegos, Internet o las compras. Por nuestra parte, proponemos que el perfil psicopatológico del perpetrador/a de un SMpP se corresponde con un trastorno adictivo, ya que tienen un comportamiento compulsivo de búsqueda del ambiente hospitalario que les supone un alto grado de gratificación y recompensa, y que se incrementa progresivamente ante nuevas situaciones de estrés. Se muestran tres casos clínicos de SMpP que pertenecen a la serie de 19 víctimas con diagnóstico confirmado del síndrome, que estudiaron los autores en un conjunto de 54 casos con sospecha de ser víctimas de Munchausen por poderes enviadas desde Pediatría al presentar los signos de alarma que definió Meadow. El propósito de este trabajo es aportar nuevos datos que faciliten una segura y adecuada intervención caso de encontrarse con esta extrafia y sutilmente peligrosa enfermedad (AU)

In Munchausen syndrome by proxy (MSBP), one of the parents, in 95% of the cases the mother per se, invents,falsifies and makes up clinical symptoms in their child until the child becomes a patient for the physicians and pediatricians. The last Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has introduced the Gaming Disorders in the chapter of Addictive Disorders, opening the way to the possibility of incorporating other problematic behaviors of addictive risk not referring to substances, such as video games, Internet, or shopping. On our part, we propose that the psychopathological profile of the author of a MSBP corresponds with an Addictive Disorder, since they share a behavior of compulsive seeking of the hospital setting that means a high grade of gratification and rewards and that progressively increases when their are new stress situations. Three clinical cases of MSBP belonging to a series of 19 victims with confirmed diagnosis of the syndrome studied by the authors in a group of 54 cases with suspicion of being victims of the Munchausen syndrome by proxy referred from pediatrics due to the presentation of Meadow-defined alarm signs are shown. The purpose of this work is to provide new data facilitating 21 safe and adequate case intervention if faced with this rare and subtly dangerous disease (AU)

Síndrome de Munchausen por poderes: presentación de un caso y revisión de la literatura / Munchausen Syndrome by proxi: case presentation and review of the literature

Paciente de 9 años referido para evaluación por múltiples quejas somáticas luego de descartarse patología orgánica en forma exhaustiva. Según su madre tenía una enfermedad rara, mostrándose enfadada porque no se había hospitalizado a su hijo (había sido visto en pediatría, gastroenterología, neurología, urología, etc.). El niño permaneció en todo momento callado, retraído, no permitiendo la madre que sea evaluado solo. La madre acudía repetidamente a su pediatra con su hijo por sintomatología inespecífica, reclamaba que se le hicieran analíticas y pruebas invasivas a su hijo y cuando no se accedía o se le decía que eran normales, se molestaba y reclamaba que se le derive a un especialista. En el artículo se hace una revisión acerca del Síndrome de Munchausen por poderes (AU)

9 year old patient referred for evaluation by multiple somatic complaints after exhaustively ruling out organic pathology. According to his mother he had a rare disease, showing upset because her child had not been hospitalized (he had seen in pediatrics, gastroenterology, neurology, oncology, etc.). The boy remained silent at all times, withdrawn, not allowing the mother to evaluate him alone. The mother repeatedly came to the pediatrician with her child for unspecific symptoms, claiming to do invasive test, and when doctors refused or she was told they were normal, she became upset and claimed to be referred to a specialist. In this article we do a review about Munchausen syndrome by proxy (AU)

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.

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.

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.

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.

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.

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: a case report.

Munchausen syndrome by proxy is difficult to diagnose unless healthcare providers are astute to its clinical features and management. A case is presented to educate nurses and advanced practice nurses, of the nursing, medical, legal, and social complexities associated with Munchausen syndrome by proxy. This article also provides a brief review of the definition of Munchausen syndrome by proxy, its epidemiology, common features of the perpetrator, implications for healthcare personnel, and the legal and international ramifications of Munchausen syndrome by proxy.

Episodios paroxíticos de origen psicógeno / Non-epileptic psychogenic episodes

La crisis psicógenas no epilépticas son un patrón de conducta paroxística que asemeja crisis epilépticas y se inicia por mecanismos psicológicos. En este capítulo revisamos este tipo de episodios que con relativa frecuencia plantean un problema de diagnóstico diferencial en nuestros servicios de urgencias así como en las consultas externas, teniendo importante repercusión tanto a nivel de consumo de recursos diagnósticos y terapéuticos para el sistema sanitario, como a nivel psico-emocional para la familia incluso para el propio paciente, el cual puede estar recibiendo tratamientos no adecuados por periodos prolongados de tiempo hasta que se llega al diagnóstico definitivo (AU)

Non-epileptic psychogenic seizures are a paraxystic behaviour pattern that looks like an epileptic seizure and starts by psychological mechanism. In this chapter we review this disorders that represents, with a relative frequency, a differential diagnosis challenge either on emergencies or in medical consultation, having a high impact on diagnostic and therapeutic resources consumption, as much as to the familiar psycho-emotional status or even the patient itself, who might be taking non-adequate treatments for a long time periods until having a correct diagnosis (AU)

Munchausen syndrome by proxy with massive proteinuria and gastrointestinal hemorrhage.

A 5-year-old boy presented with acute abdominal pain. Massive proteinuria of 10 g/1.73 m(2) per day was detected on standard urinalysis. There was no peripheral edema. Serum concentrations of total proteins, lipids, and creatinine and immunological investigations were normal. Two kidney biopsies revealed no abnormalities. Several weeks later he was admitted for intestinal hemorrhage with significant anemia. Endoscopy of the esophagus, stomach, colon, and small bowel (via laparotomy) were normal. Electrophoresis of urine proteins revealed the unusual finding of an albumin fraction of 99.4%. During a routine check-up in the outpatient clinic fresh urine samples were obtained while the boy's mother was absent. These were all negative for protein. The mother, who was a nurse, finally confessed to adding human albumin to the urine samples.