Factitious lesions of the hand

Abstract

Objective The presence of a lesion with atypical presentation, obscure clinical history, which does not improve with classic treatments, shall raise the red flag of the medical team. In such cases, the hypothesis of a factitious lesion shall be considered. Many times the correct diagnosis on the initial assessment may avoid high-cost diagnostic tests, unnecessary treatments, and time consumption of the medical team. We present here two classic cases of factitious lesions that, similar to those described in the literature, is difficult to diagnose and difficult to treat.

Secretan Syndrome: A Fluctuating Case of Factitious Lymphedema

“…ecretan syndrome (SS) represents a recurrent or chronic form of factitious lymphedema, usually affecting the dorsal aspect of the hand. [1][2][3] It is accepted as a subtype of Munchausen syndrome whereby the patient self-inflicts and simulates lymphedema. 1,2 Historically, many of the cases reported with the term Charcot's oedème bleu are now believed to represent clinical variants of SS.…”

“…[1][2][3] It is accepted as a subtype of Munchausen syndrome whereby the patient self-inflicts and simulates lymphedema. 1,2 Historically, many of the cases reported with the term Charcot's oedème bleu are now believed to represent clinical variants of SS. [4][5][6]…”

“…4,11,12 Patients with SS typically visit several hospitals or institutions; see many physicians; and willingly accept, request, and undergo unnecessary extensive, invasive, and costly diagnostic and therapeutic procedures and prolonged hospitalizations. 1,2,5,12 The disorder promptly responds to immobilization and elevation of the limb. 2,4 Plaster casts may prove useful in prevention of compression and thus amelioration of the lymphedema.…”

“…1,2,5,12 The disorder promptly responds to immobilization and elevation of the limb. 2,4 Plaster casts may prove useful in prevention of compression and thus amelioration of the lymphedema. 1,4,6 Once the diagnosis is confirmed, direct confrontation should be avoided and ideally the patient should be referred for psychiatric evaluation.…”

“…1,4,6 Once the diagnosis is confirmed, direct confrontation should be avoided and ideally the patient should be referred for psychiatric evaluation. 1,2,4,5,8,12 If the patient admits self-inflicting behavior, psychotherapy and/or behavior modification therapy along with psychotropic medications may be helpful to relieve emotional and behavioral symptoms. 12 Unfortunately, if the patient denies a self-inflicting role in the occurrence of lymphedema and persists in self-injurious behavior, psychotherapy or psychotropic medications will be futile.…”