The term Munchausen syndrome is used to describe a situation where a person inflicts an illness or injury
on self. Munchausen syndrome by proxy is when a person fabricates an illness on behalf of another. We
report the case of an injection drug user admitted to the hospital for a spinal epidural abscess which was
drained, treated with antibiotics and doing well, suddenly becoming very sick and febrile on day 17. The
blood cultures grew a total of 12 organisms including 2 fungi. Someone who visited the patient in the
hospital around this time was suspected to have injected a solution of drugs brought from home directly into
the patient’s intravenous line used to administer antibiotics resulting in a polymicrobial
bacteremia/fungemia. Presence of Lactobacilli in one blood culture raised the suspicion that the girl friend
who was also a drug user, may have been responsible as Lactobacilli are more frequently found in hands of
females. We caution physicians and nurses to be vigilant when handling injection drug users and other drug
abusers admitted to hospital. Materials brought to the patient’s room from outside must be screened. New
onset of unexpected symptoms should alert caregivers of the possibility of such abuse.