Case reports: successful treatment of Mycobacterium marinum infection with minocycline after complication of disease by delayed diagnosis and systemic steroids.

Mycobacterium marinum, an aerobic, non-tuberculous, environmental mycobacterium, is the etiologic agent responsible for "fish tank granuloma." Found in aquatic environments, particularly where water is relatively still or stagnant, M. marinum produces infection in fish, as well as humans. Infection follows exposure to contaminated water and direct inoculation of the organism via breaks in the skin. The resulting primary lesion is usually a red-to-violaceous plaque or nodule, which can have an overlying crust or verrucous surface that may ulcerate and, in some cases, may be accompanied by satellite lesions and lymphangitic spread. We present an aggressive case of M. marinum infection with prominent lymph node involvement in an otherwise healthy 34-year-old woman whose course was complicated by delayed diagnosis and treatment with systemic steroids.

Autopsy confirmation of severe pulmonary interstitial fibrosis secondary to Munchausen syndrome presenting as cystic fibrosis.

Chronic factitious disorder with physical symptoms, or Munchausen syndrome, is a well-recognized but uncommonly diagnosed psychiatric condition characterized by the deliberate production of signs and symptoms of disease in order to receive medical attention. Clinical suspicion of this disease is rarely confirmed by autopsy, as the patients usually do not die as a consequence of feigning illness. Here we report the autopsy confirmation of a case of a suspected Munchausen syndrome patient who presented with a history of cystic fibrosis. Examination of the lungs demonstrated extensive severe interstitial fibrosis, and polariscopic examination revealed a large quantity of crystalline material throughout the tissue; X-ray diffraction identified the material as talc. Synopses of published cases of Munchausen syndrome presenting as cystic fibrosis, and cases of Munchausen syndrome with pulmonary talcosis are presented as part of the discussion.