Munchausen syndrome – forgotten but dangerous disease. Diagnostic challenges in female patient
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Katedra i Oddział Kliniczny Psychiatrii, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach
Oddział Anestezjologii i Intensywnej Terapii, Wojewódzki Szpital Specjalistyczny nr 4 w Bytomiu
Katedra i Zakład Radiologii Lekarskiej i Radiodiagnostyki, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach
PSYCHOMedical w Bielsku-Białej
Mariusz Sołtysik   

Katedra i Oddział Kliniczny Psychiatrii, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach, Wielospecjalistyczny Szpital Powiatowy nr 3, ul. Pyskowicka 47–51, 42-600 Tarnowskie Góry
Ann. Acad. Med. Siles. 2018;72:203–208
According to the International Statistical Classification of Diseases and Related Health Problems ICD-10, Munchausen syndrome is a mental disorder classified as an F68.1 diagnosis code – “Intentional production or feigning of symptoms or disabilities, either physical or psychological [factitious disorder]”. In contrast to people consciously simulating ailments for specific benefits, patients with suspected Munchausen syndrome persistently contacting health care providers are not aware of their inner motives (social gratification, need for control, high levels of self-harm), exposing themselves to a long diagnostic process.

To present the difficulties associated with differentiation, diagnosis and appropriate treatment of Munchausen syndrome. The presented case study concerns a young patient repeatedly hospitalized due to numerous somatic complaints. Despite many physical examinations, including imaging and treatment no diagnosis could be made which would explain all of the symptoms. Only psychiatric hospitalization, with full analysis of the patient’s medical history, made it possible to diagnose the Munchausen syndrome and to treat the patient accordingly. Paradoxically, that diagnosis might have contributed to undermining subsequent problems reported by the patient that emerged because of an expanding brain tumor.

Proper understanding of the symptoms presented by the patient could have lead to a faster diagnosis. However, the later fatal symptoms show that one cannot focus on only one diagnosis. Properly planned imaging seems to play a huge role.

Asher R. Munchausen’s syndrome. Lancet 1951; 1(6650): 339–341.
Bürger G.A. Przygody Münchhausena. Wyd. Nasza Księgarnia. Warszawa 1956.
Pudlo M., Pudlo R., Leszczyk-Baranowska M., Przybyło-Partyka M. Trudności diagnostyczne u pacjenta z zespołem Münchhausena. Post. Psychiatr. Neurol. 2005; 14(supl. 1/20): 111–114.
Klasyfikacja zaburzeń psychiatrycznych i zaburzeń zachowania. w ICD-10. Kraków: Uniwersyteckie Wydawnictwo Medyczne „Vesalius”; 2000.
Berent D., Florkowski A., Gałecki P. Przeniesiony zespół Münchausena. Psychiatr. Pol. 2010; 44(2): 245–254.
Janas-Kozik M., Albert J., Kresimon E., Stokowacka-Zakrzewska M., Wawrzyniak K. Choroba somatyczna czy zespół Munchausena z przeniesie-nia? Choroba matki czy dziecka? Kontrowersje diagnostyczne. Przegl. Lek. 2007; 64(Supl. 3): 72–75.
Goodwin J. Munchausen’s Syndrome as a Dissociative Disorder. Dissociation: Progress in the Dissociative Disorders 1988; 1(1): 54–60.
Meadow R. False allegations of abuse and Munchausen syndrome by proxy. Arch. Dis. Child. 1993; 68(4): 444–447.
Ferrara P., Vitelli O., Romani L., Bottaro G., Ianniello F., Fabrizio G.C. Vena F., Del Volgo V., Caporale O., Pecoraro R., Miconi F. et al. The Thin Line between Munchausen Syndrome and Munchausen Syndrome by Proxy. J. Psychol. Abnorm. Child. 2014; 3: 2, doi:10.4172/2329-9525.1000115.
Criddle L. Monsters in the Closet: Munchausen Syndrome by Proxy. Crit. Care Nurse 2010; 30(6): 46–55, doi: 10.4037/ccn2010737.
Reich P., Gottfried L.A. Factitious disorder in a teaching hospital. Ann. Intern. Med. 1983; 99(2): 240–247.
Fishbain D.A., Goldberg M., Rosomoff R.S., Rosomoff H.L. Münchausen syndrome presenting with chronic pain: Case report. Pain 1988; 35(1): 91–94, doi: 10.1016/0304-3959(88)90280-1.
Robbins L. Munchausen’s syndrome presenting as cluster headache. Headache Quart. 2002; 13(2): 121–122.
Fénelon G., Mahieux F., Roullet E., Guillard A. Munchausen’s syndrome and abnormalities on magnetic resonance imaging of the brain. BMJ 1991; 302(6783): 996–997.
Baker C.E., Major E. Munchausen’s syndrome. A case presenting as asthma requiring ventilation. Anaesthesia 1994; 49(12): 1050–1051.
Lauwers R., Van De Winkel N., Vanderbruggen N., Hubloue I. Munchausen syndrome in the emergency department mostly difficult, sometimes easy to diagnose: a case report and review of the literature. World J. Emerg. Surg. 2009; 4: 38, doi: 10.1186/1749-7922-4-38.
Kwan P., Lynch S., Davy A. Munchausen’s syndrome with concurrent neurological and psychiatric presentations. J R Soc. Med. 1997; 90(2): 83–85.
Grzyb W., Kępska A., Sysa-Jędrzejowska A., Zalewska-Janowska A. Zespół Munchausena. Dermatol. Klin. 2006; 8(4): 281–283.
Ameratunga R., Casey P., Parry S., Kenedi C. Hypogammaglobulinemia factitia – Munchausen syndrome masquerading as common variable immune deficiency. Allerg. Asthma Clin. Immunol. 2013; 9(1): 36, doi:.1186/1710-1492-9-36.
Steel R.M. Factitious disorder (Munchausen’s syndrome). J R Coll. Physicians Edinb. 2009; 39(4): 343–347, doi: 10.4997/JRCPE.2009.412.