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Forensic Sci Med Pathol 2020 Jun 11. Epub 2020 Jun 11.

Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Factitious disorders (FD) like Munchausen syndrome are well known to most physicians, yet the corresponding ICD-10 diagnosis F68.1 remains severely under-assigned and often misdiagnosed. To approach this problem, we conducted a nationwide inquiry for Germany and Norway as well as a comparison between these two countries regarding the incidence of diagnosis of FD. Read More

Am J Hematol 2020 Jul 21;95(7):809-816. Epub 2020 Apr 21.

UOC Ematologia, Istituto Giannina Gaslini, Genoa, Italy.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is curative for bone marrow failure in patients with Fanconi anemia (FA), but the presence of a malignant transformation is associated with a poor prognosis and the management of these patients is still challenging. We analyzed outcome of 74 FA patients with a diagnosis of myelodysplastic syndrome (n = 35), acute leukemia (n = 35) or with cytogenetic abnormalities (n = 4), who underwent allo-HSCT from 1999 to 2016 in EBMT network. Type of diagnosis, pre-HSCT cytoreductive therapies and related toxicities, disease status pre-HSCT, donor type, and conditioning regimen were considered as main variables potentially influencing outcome. Read More

South Med J 2020 Apr;113(4):198-200

From the University of Louisville School of Medicine, Louisville, Kentucky.

Munchausen syndrome is a factitious disorder that is difficult to diagnose and treat. This article clarifies points for clinical recognition and management of patients with this condition. Patients with this condition often are dramatic and provide false and/or exaggerated symptoms or information. Read More

J Crit Care 2020 Jun 19;57:124-129. Epub 2020 Feb 19.

Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany. Electronic address:

Purpose: Life-threatening complications of CD-19 Chimeric antigen receptor - T (CAR-T) cells such as the cytokine release syndrome (CRS)) have been reported. Treatment is limited to IL-6 blockade and steroids although global removal of elevated soluble inflammatory factors might be more effective.

Methods: Clinical course of a CRS patient treated with extracorporeal cytokine adsorption (Cytosorb®). Read More

Internist (Berl) 2020 Mar;61(3):321-325

Innere Medizin, Stiftungsklinik Weißenhorn, Klinik der Kreisspitalstiftung, Weißenhorn, Deutschland.

A 32-year-old woman with maple syrup urine disease presented with recurring episodes with hypoglycaemia and cerebral seizures. In most cases a connection to the inborn metabolic disorder is assumed, resulting in symptomatic treatment. Due to these treatments invasive procedures are required. Read More

J Infus Nurs 2020 Jan/Feb;43(1):39-46

Forrest General Home Care and Hospice, Hattiesburg, Mississippi. Janet P. McMillan, DSN, APRN, PMHNP-BC, ACHPN, CNE, is certified as both a psychiatric nurse practitioner and an advanced hospice and palliative care nurse. She draws her experience from her extensive nursing career, which began in 1982. For the past 20 years, Dr McMillan has worked in the home health and hospice fields providing care to patients with mental health needs.

Factitious disorder, formerly known as Munchausen syndrome, is a type of mental illness in which patients fabricate symptoms to gain attention or sympathy. When considering a patient with factitious disorder as a candidate for infusion therapy, the clinician must be aware of the challenges associated with providing an invasive treatment to high-risk patients while promoting safety. Read More

Br J Nurs 2019 Nov;28(20):1288-1290

Staff Nurse, Paediatric Critical Care, Royal Manchester Children's Hospital.

Ir J Med Sci 2020 May 12;189(2):627-631. Epub 2019 Nov 12.

Department of Haematology, Odense University Hospital, J.B. Winsløws Vej 4, DK 5000, Odense, Denmark.

Background: A considerable amount of research has been put into the explanation of the origin of the vampire myth by focussing on possible symptoms of the vampire; however, very little attention has been given to the victims.

Aims: To elucidate whether the myth of vampire victims follows the course of disease of acute leukaemia.

Method: We studied three classical vampire novels published 1819-1897, focusing on 8 victims and their symptoms. Read More

J Clin Psychol Med Settings 2019 Oct 14. Epub 2019 Oct 14.

Department of Psychiatry & Behavioral Sciences, Stanford University Medical School, Stanford, CA, USA.

Munchausen by proxy refers to an individual who abusively and compulsively falsifies physical, psychiatric or developmental disorders in a child or adult victim in order to satisfy a psychological need. Factitious disorder imposed on another refers to the psychopathology in the abuser. Psychologists in medical settings may: (1) identify patients they come to suspect as being victims or perpetrators of MBP, (2) conduct or assist in clinical or forensic evaluations; (3) offer recommendations for clinical case management, and/or (4) provide treatment or referrals. Read More

Haematologica 2020 Jul 10;105(7):1977-1983. Epub 2019 Oct 10.

Medical University of Warsaw, Warsaw, Poland.

Uric acid is a danger signal contributing to inflammation. Its relevance to allogeneic stem cell transplantation (alloSCT) derives from preclinical models where the depletion of uric acid led to improved survival and reduced graft--host disease (GvHD). In a clinical pilot trial, peri-transplant uric acid depletion reduced acute GvHD incidence. Read More

Healthcare (Basel) 2019 Oct 8;7(4). Epub 2019 Oct 8.

Retired, Plantation, FL, USA. Retired Associate Professor of Pharmacology and Physiology, NJ Medical School, Newark, NJ 07103, USA.

There is often difficulty differentiating between psychosomatic, somatopsychic, multisystem illness, and different degrees of medical uncertainty. Uncommon, complex, and multisystem diseases are commonly misdiagnosed. Two case histories are described, and relevant terms differentiating psychosomatic, somatopsychic, and multisystem illnesses are identified, reviewed, and discussed. Read More

Clin Cosmet Investig Dermatol 2019 11;12:679-681. Epub 2019 Sep 11.

Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.

Patients that suffer from factitial dermatosis mutilate their skin, often lacking any consciousness of self-injury, attributing the resulting lesions to spontaneous development. The case hereby described shows how the health providers' interventions led a patient from a baseline undiagnosed factitious disorder to frank delusions of infestation with , and a relentless search for antibiotic treatments. We highlight the need for educating health practitioners on the characteristics of psycho-cutaneous disorders. Read More

Indian J Ophthalmol 2019 10;67(10):1693-1694

Department of Vitreoretinal Services, Prabha Eye Clinic and Research Centre, Bengaluru, Karnataka, India.

J Community Hosp Intern Med Perspect 2019 5;9(4):369-370. Epub 2019 Sep 5.

Mayo Clinic Health System Mankato.

J Med Case Rep 2019 Sep 12;13(1):287. Epub 2019 Sep 12.

Department of Respiratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.

Background: Rapid diagnosis and appropriate treatment of Munchausen syndrome is important not only for the patient but also for health care workers because a delay in diagnosis can worsen patients' clinical outcomes, and result in a substantial medical cost.

Case Presentation: A young and previously healthy 24-year-old Japanese woman, a nurse, presented with complaints of refractory abscess on her left upper limb for 3 months. A physical examination on admission revealed low-grade fever and a subcutaneous abscess in her left forearm. Read More

Cutis 2019 Jul;104(1):E8-E9

Department of Dermatology, Division of Pediatric Dermatology, Johns Hopkins University School of Medicine, Baltimore, USA.

Br J Gen Pract 2019 09 29;69(686):464-465. Epub 2019 Aug 29.

Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire.

Dermatol Online J 2019 May 15;25(5). Epub 2019 May 15.

Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL.

Factitious disorder imposed on self is characterized by self-induction. Dermatitis artefacta, the cutaneous subtype of factitious disorder imposed on self, can have a variety of atypical presentations. A 36-year-old woman with an extensive past medical history presented with painful nodules on her abdomen, thighs, and arms. Read More

J Am Acad Psychiatry Law 2019 Aug 10;47(3):325-334. Epub 2019 Jun 10.

Dr. Matto is Assistant Clinical Professor of Psychiatry, Dr. McNiel is Professor of Clinical Psychology, and Dr. Binder is Professor of Psychiatry in the Department of Psychiatry, University of California, San Francisco. This article was presented, in part, at the 47th annual meeting of the American Academy of Psychiatry and the Law, October 27-30, 2016, in Portland, Oregon.

Posttraumatic stress disorder (PTSD) can occur after a traumatic experience and can cause severe symptoms that interfere with a person's psychological, physical, interpersonal, occupational, and social functioning. It is important to accurately identify genuine cases of PTSD and, as part of the differential diagnosis, to rule out instances of false PTSD. False PTSD diagnoses can adversely affect treatment planning, resource management, and research. Read More

Clin Dermatol 2019 May - Jun;37(3):268-277. Epub 2019 Jan 11.

Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

The self-induced dermatoses represent about 2% of dermatology patient visits, and include the recurrent body-focused repetitive behaviors (BFRB) (skin-picking or excoriation disorder, trichotillomania, onychophagia and onychotillomania), dermatitis artefacta, and features of other psychiatric disorders, for example, secondary to excessive grooming in body dysmorphic disorder, skin picking in delusional infestation, or secondary to self-harm in depressive disease. Among the BFRBs, onychophagia and onychotillomania are most likely to be associated with lesions that mimic other dermatologic conditions (eg, nail psoriasis, lichen planus, vasculitis, onychomycosis, melanoma). Dermatitis artefacta (DA) describes lesions that are self-inflicted with the intention of assuming a sick role in the absence of obvious external rewards. Read More

Hautarzt 2019 Nov;70(11):883-887

Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.

We present four clinicopathological correlated cases of young patients with cryothermic dermatitis artefacta. They were initially misdiagnosed as primary bullous dermatoses or fixed drug eruptions. Cryothermic dermatitis artefacta can imitate authentic dermatoses such as linear IgA bullous dermatosis, herpes virus infection, bullous pemphigoid or fixed drug eruption. Read More

J Wound Care 2019 06;28(Sup6):S1-S92

Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain.

Handchir Mikrochir Plast Chir 2019 06 5;51(3):211-212. Epub 2019 Jun 5.

Reumatologia 2019 29;57(2):106-108. Epub 2019 Apr 29.

Department of Internal Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil.

A 31-year-old Caucasian woman with a history of anxiety disorder presented with chronic ulcerative lesions of the skin in arms and legs, treated initially as cutaneous vasculitis, evolving with relapsing during corticosteroid tapering, was diagnosed, after thorough investigation and no organic disease found, with dermatitis artefacta - a self-inflicted harm due to psychological disorders. Dermatitis artefacta is a rare condition, more frequent in women, in which traumatic skin lesions are caused by the patient him/herself, over accessible parts of the body, due to personality disorders. Clinicians should be aware of this alternative aetiology, especially as a differential diagnosis for refractory cutaneous vasculitis. Read More

Med Leg J 2019 Jun 20;87(2):73-76. Epub 2019 May 20.

Delusional health beliefs can be difficult and costly for practitioners to diagnose and manage. Patients often deny that mental distress is the cause of their illness, when it may be the most significant factor. Such patients can be relentless in their pursuit of a physical cause and go from doctor to doctor to find one who agrees with them, using up significant NHS resources. Read More

Int J Pediatr Otorhinolaryngol 2019 Aug 25;123:75-78. Epub 2019 Apr 25.

Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA.

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. Read More

BMJ Case Rep 2019 May 9;12(5). Epub 2019 May 9.

Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Factitious disorder (FD) has diverse presentations but neurological presentation is unusual. In this report, we discuss a case of FD who presented with triparesis, that is, weakness of both lower limbs and right upper limb. Diagnosis of FD was made after detailed clinical evaluation, review of past medical records that revealed extensive evaluation to rule out physical illness, and inability to find any associated stressful event or material gain associated with illness. Read More

BMJ Case Rep 2019 Apr 29;12(4). Epub 2019 Apr 29.

Endocrinology and Metabolism, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India.

Thyrotoxicosis factitia, a disorder frequently seen in young or middle-aged women with psychological disorders, most commonly results from surreptitious ingestion of excess thyroid hormones. In most patients, diagnosis is relatively straightforward and depends on the demonstration of biochemical thyrotoxicosis, suppressed endogenous thyroid function and absence of clinical features of underlying thyroid disease. However, at times, confounding factors can make the diagnosis particularly challenging and necessitate the investigating physician to don the detective's cap to get to the root of the problem. Read More

Australas Psychiatry 2019 Oct 29;27(5):456-461. Epub 2019 Apr 29.

Consultant Psychiatrist, Consultation Liaison Psychiatry Department, Gosford Hospital, Gosford, NSW, Australia.

Objectives: To explore the presence of dopamine dysregulation syndrome in non-Parkinson's disease patients receiving dopamine replacement therapy.

Methods: Electronic searches were conducted of Medline, Embase, PsycINFO and PreMedline to capture articles related to dopamine misuse or factitious disorder combined with the presence of dopamine replacement therapy or a non-Parkinson's disease population. In total, 430 articles were reviewed and studies that addressed dopamine dysregulation syndrome in non-Parkinson's disease patients were included. Read More

Breast J 2019 05 13;25(3):526-527. Epub 2019 Apr 13.

Breast Cancer Center, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.

Behav Neurol 2019 3;2019:3891809. Epub 2019 Mar 3.

Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Background: Systematic studies on factitious disorders and malingering in large populations are rare. To address this issue, we performed a nationwide epidemiological study in Norway on the incidence of these diagnoses in an unselected patient population. In particular, we tried to confirm the diagnoses and to estimate the contribution of Munchausen syndrome to the spectrum of factitious disorders. Read More

Klin Padiatr 2019 07 1;231(4):212-213. Epub 2019 Apr 1.

Hospital Clinic de Barcelona, Neonatology, Barcelona, Spain.

Diagnosis (Berl) 2020 May;7(2):141-145

Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Background Although the most common cause of thyrotoxicosis is Graves' disease, the determination of the cause of thyrotoxicosis is important for establishing appropriate management. Diagnosis of surreptitious ingestion of thyroid hormones or factitious thyrotoxicosis often presents a difficult challenge especially in a patient with previously diagnosed Graves' disease. The objective of this report was to demonstrate various approaches to support the diagnosis of factitious thyrotoxicosis. Read More

J Pediatr Adolesc Gynecol 2019 Jun 25;32(3):334-336. Epub 2019 Mar 25.

Section of Adolescent Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma. Electronic address:

Background: Medical child abuse (MCA) is challenging to diagnose. Although young children are often affected, adolescents can be victims through caregiver coercion. Presentation is highly variable. Read More

PLoS One 2019 19;14(3):e0213739. Epub 2019 Mar 19.

Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.

Leukemia relapse is the main cause for mortality after allogeneic stem cell transplantation (allo-SCT). Donor-derived allo-immune responses eliminate the residual host hematopoiesis and protect against relapse. Cytomegalovirus (CMV) reactivation (CMV-R) after allo-SCT may trigger anti-leukemic effects. Read More

Am J Med Sci 2019 05 7;357(5):411-420. Epub 2019 Feb 7.

Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; Division of Hematopathology and Laboratory Genetics, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. Electronic address:

Background: The objective of this study was to describe presentation, natural history, management and long-term outcomes of patients with psychogenic purpura (PP), also known as Gardner-Diamond Syndrome.

Methods: In this retrospective study, records of patients with a diagnosis of PP seen at Mayo Clinic, Rochester from 1976 to 2016 were reviewed. Available literature regarding PP was also comparatively reviewed. Read More

Ned Tijdschr Geneeskd 2019 03 8;163. Epub 2019 Mar 8.

Huisartsenpraktijk Gunneweg en Groot, Ermelo.

A 9-year-old healthy girl visited the general practitioner with a recurring purple discoloration of the skin around the mouth without any other complaints. She was diagnosed with factitious purpura due to a vacuum that was caused by creating a negative pressure through placement of a plastic cup around the mouth. Read More

Codas 2019 Feb 21;31(1):e20180173. Epub 2019 Feb 21.

Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil.

Am J Dermatopathol 2019 03;41(3):234

Department of Dermatology, Clinical University Hospital from Valencia, Valencia, Spain.

Medicine (Baltimore) 2019 Feb;98(6):e14152

Department of Pediatrics.

Rationale: Hemoptysis or hematemesis is a common clinical symptom in adults, but is unusually to be observed in children. Hemoptysis can occur with circulatory diseases, injuries, several types of systemic diseases, or systemic factors including factitious disorder (FD), which is difficult to be diagnosed. Here, we report a case of hemoptysis caused by FD to provide a diagnostic flow chart for such kind of disease. Read More

J Cutan Med Surg 2019 May/Jun;23(3):277-281. Epub 2019 Jan 17.

3 Department of Pathology, Dental School, University of São Paulo, Brazil.

Background: The terms exfoliative cheilitis, factitial cheilitis, and morsicatio labiorum are used to describe self-inflicted lesions of the lip.

Objective: Here we report and analyze clinical, pathological, and therapeutic data on 13 patients with a form of factitial cheilitis that we believe should be considered a separate entity.

Results: Eight patients were male and 5 patients were female. Read More

Clin Child Psychol Psychiatry 2019 Jul 9;24(3):494-502. Epub 2019 Jan 9.

Yale School of Medicine, USA.

Clinical practice guidelines for informing children they have been subjected to caregiver-fabricated illness are highly limited in the current literature. This article addresses this issue by offering an ethically informed, psychological approach to the disclosure of this form of abuse to school-aged children and adolescents who have been significantly harmed. A multidisciplinary, staged model of communication which illustrates that truthful communication with children and their families is a necessary component of the recovery process is proposed. Read More

Lupus 2019 Feb 7;28(2):249-252. Epub 2019 Jan 7.

1 Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.

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. Read More

Int J Clin Pharm 2019 Feb 4;41(1):3-5. Epub 2019 Jan 4.

Public Health Institute, Liverpool John Moores University, Liverpool, UK.

Several prescription and nonprescription drugs are liable for abuse. However, oral hypoglycemic agents are among the most benign and low-risk drugs in terms of abuse liability. This commentary intends to raise awareness regarding the abuse of a particular type of oral hypoglycemic agent, namely sulfonylurea drugs, used to experience mental-altering effects for its euphoric "hypoglycemic rush. Read More

Br Dent J 2018 12;225(12):1063-1066

Department of Oral & Maxillofacial Surgery, Ulster Hospital, Dundonald, Northern Ireland.

Patients with factitious disorder typically present with signs or symptoms suggesting a medical problem, but which transpire to be self-induced or fabricated. Repeated investigations and treatments are often carried out to no avail before this possibility is considered. In this case, a 51-year-old female presented to the oral and maxillofacial surgery unit with toothache and a facial rash. Read More

J Dermatol 2019 Jun 19;46(6):e222-e224. Epub 2018 Dec 19.

Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

J Fr Ophtalmol 2019 Jan 10;42(1):e15-e17. Epub 2018 Dec 10.

Ophtalmologiste libérale, 17, rue du Colonel Rabier, 58200 Cosnes-sur-Loire, France.

JAMA Dermatol 2019 Mar;155(3):373-374

Department of Dermatology, University Hospital Leipzig (UKL), Germany.