Recurrent Deep Ulcers Resembling Rare Cancers as a Form of Factitious Disorder

Okuniewska, Aleksandra; Walczuk, Beata Imko; Czubek, Maria; Biernat, Wojciech

doi:10.2340/00015555-1027

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…A 60‐year‐old woman developed life‐threatening bone marrow suppression, aseptic hip necrosis, transfusion‐dependent thrombocytopenia and a chronic pain syndrome after being treated for recurrent deep ulcers resembling rare cancers. The ulcers were later confirmed as dermatitis artefacta—histopathology demonstrated traces of wood in the deeper scar tissues . She later developed aplastic anemia after covert ingestion of oral busulfan and polymicrobial sepsis possibly secondary to the self‐injection of feces into her central line.…”

Section: Discussionmentioning

confidence: 99%

Factitious disorder (Munchausen's syndrome) in oncology: case report and literature review

et al. 2015

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Background Factitious disorder is where patients repeatedly seek medical care for feigned illnesses in the absence of obvious external rewards; ‘Munchausen’s syndrome’ is the historical name for this disorder. Method We report on a case that was presented to a tertiary oncology center as a suspected rare bone cancer. Results and Conclusions Psychosocial clinicians working in oncology settings should be aware of the complexities of diagnosing factitious disorder in cancer settings where empathy is prominent and suspicion unusual. Moreover, comorbidity can cloud the diagnosis (in this case substance abuse), and, even when accurately diagnosed, there are no evidence-based management approaches to offer to the patient. What seems to linger most after the patient is discharged, usually in a huff, are strong counter-transference feelings and substantial medical bills.

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Section: Discussionmentioning

confidence: 99%

Factitious disorder (Munchausen's syndrome) in oncology: case report and literature review

et al. 2015

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“…Note the circular nature of the necrotic eschar. The periphery as well as the distal aspects of the flap is well perfused and viable workers or have a family member who is part of this field, with women being 4-20 fold more prone to this condition than men [3,4].…”

Section: Discussionmentioning

confidence: 99%

“…The presenting clinical picture of MunS patients to the surgeon varies. One of the most common presentations is recurrent chronic non-healing ulcers, which can be confused with malignancy, infection, vasculitis, intrinsic wound healing problems or autoimmune diseases [4,5]. Wallace et al described the SHAFT syndrome for hand patients as a variant of MunS, in which Sad, Hostile, Anxious, Frustrating, and Tenacious (SHAFT) patient will try to convince the surgeon to operate on their hands for secondary psychological or financial gain [6].…”

Section: Discussionmentioning

confidence: 99%

How to Kill a Flap: Munchausen Syndrome — A Silent Trap for Plastic Surgeons

2016

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“…30,34,43,50 Lack of stable relationships is common as these patients may have a history of neglect during childhood, disruptive family ties, poor interpersonal relationships, and estrangement from their families. 5,44,51 Consequently, families are frequently unavailable for contact. 49 Patients with Munchausen syndrome often have some medical training.…”

Section: Management Of Munchausen Syndromementioning

confidence: 99%

“…23,68 It is consistently recommended that a psychiatry team be consulted as early as possible. 23,24,26,29,30,31,34,39,48,49,51,53,58,64,66,[69][70][71][72][73][74][75][76] The psychiatry team's most important role is to help the primary treatment team manage the patient in the safest, most appropriate way, which includes setting compassionate but firm limits and steering the patient toward psychiatric care in an empathic and facesaving nonconfrontational manner. 34 Patients may react to confrontation with symptom escalation to substantiate the legitimacy of their needs, putting themselves at risk for more self-harm.…”

Section: Management Of Munchausen Syndromementioning

confidence: 99%

Munchausen Syndrome: A Review of Patient Management

Wong¹,

Detweiler²

2016

Psychiatric Annals

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The management of Munchausen syndrome is fraught with complexities related to legality, ethics, and its inherent nature. An illustrative case of factitious aortic dissection is presented as well as a review of the literature for the management Munchausen syndrome, which includes strategies reported to be effective. Management of Munchausen syndrome requires a high index of suspicion, a good history, and thorough physical examination. Objective illnesses resulting from the factitious behavior should be treated, while avoiding unnecessary procedures. Early referral to a psychiatry team is critical as this may be an empathetic and face-saving approach for the patient. Regularly scheduled appointments, not dependent on the patient's distress level, are associated with improved long-term prognosis. Patients with Munchausen syndrome can suffer considerable iatrogenic morbidity and mortality, and they place immense strain on the health care system. Physicians should be aware of the complexities of these cases, the management options, and the frequent need for psychiatry consultations [Psychiatr Ann. 2016;46(1):66-70.] M unchausen syndrome is the most severe and chronic form of factitious disorder imposed on the self, with predominantly physical signs and symptoms, pseudologia fantas-tica, and peregrination (frequent traveling from one medical center to another) that often lead to recurrent hospitalizations. It tends to have a refractory course. Munchausen syndrome is unique because it is a psychiatric disorder that most frequently presents as an apparently severe illness in the non-psychiatric setting. Even though Munchausen syndrome is studied by most clinicians in training, the first case often leaves them feeling blindsided by the patient, creating a fractured clinicianpatient rapport. Many clinicians remember their first Munchausen syndrome case as if they were seeing medicine through a distorted prism and struggle with residual conflicting thoughts, as the clinical and ethical implications can be challenging. Munchausen syndrome was first described by Dr. Richard Asher in his landmark 1951 article. 1 He had named the

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Recurrent Deep Ulcers Resembling Rare Cancers as a Form of Factitious Disorder

Cited by 6 publications

References 9 publications

Factitious disorder (Munchausen's syndrome) in oncology: case report and literature review

Factitious disorder (Munchausen's syndrome) in oncology: case report and literature review

How to Kill a Flap: Munchausen Syndrome — A Silent Trap for Plastic Surgeons

Munchausen Syndrome: A Review of Patient Management

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