Munchausen syndrome: a case report

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  • SAKAI Tetsuya
    Department of Anesthesiology, Nagasaki University School of Medicine
  • SUMIKAWA Koji
    Department of Anesthesiology, Nagasaki University School of Medicine

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  • ミュンヒハウゼン症候群の１症例
  • ミュンヒハウゼン ショウコウグン ノ 1 ショウレイ

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Description

Factitious disorder is characterized by intentional feigning of physical or psychological symptoms and signs. Munchausen syndrome is a subtype of factitious disorder that shows predominantly physical signs and symptoms. We report a patient with Munchausen syndrome who showed complex regional pain syndrome-like symptoms and signs. A 47-year-old man on a wheelchair, who complained of lumbago, pain in the extremities, and inability to walk, was referred to our department. Lumbar magnetic resonance imaging did not show apparent abnormalities. He happened to be seen walking without difficulty outside the hospital by one of our staff. He continuously complained of various symptoms including discomfort of the pharyngolarynx and abdomen, pain in the upper jaw, pyrexia, and so on. Physical and laboratory examinations did not show any abnormalities. Eight months later, swelling of the right arm developed after he underwent transposition of the ulnar nerve for right cubital tunnel syndrome, suggesting complex regional pain syndrome. He complained of abdominal discomfort 11 months later. CT of the abdomen disclosed clips and nuts in the bowel. Three years later, the swelling of the right upper limb worsened suddenly. He was witnessed squeezing his own right upper limb with a bandage. It is important that medical staff suspect Munchausen syndrome when patients complain of various inexplicable symptoms and signs.

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