Wednesday July 23, 2008


Q: 26 year old male presented to emergeny department with severe (10/10 in severity) abdominal pain. CT scan is perfectly normal. All lab works reported normal. Patient responded to pain killer and was admitted to hospital for observation and discharged next day. 2 days later patient presented with complain of witnessing bright red blood in stool. Again all workup, along with upper and lower GI scope is negative. Patient didn't ask for any pain medicine. Just before discharge, patient called nurse with statement - "I am having hematuria" and indeed urine appears reddish as well as UA showed RBCs. Ultrasound of KUB reported negative. Urology consult obtained for scope and was without any finding. While in recovery area after Cystoscopy, patient complaint of substernal chest pain and now admitted to your ICU. Initial cardiac enzymes are normal. Your diagnosis (Choose one)

A. Undiagnosed Pernicious anemia

B. Hemolytic anemia

C. Munchausen Syndrome

D. Subclinical Rhabdomyolysis



Answer: Munchausen Syndrome

Munchausen syndrome is a condition in which patient fake disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. This "factitious disorders" are either self-induced or falsified. Other common name is hospital addiction syndrome.

Patients with Munchausen's Syndrome are usually knowledgeable about the practice of medicine and medical terminologies, and are able to manipulate physicians by inducing fever with warm coffee in mouth, making stool tarry with iron tablets or urine bloody with a drop of blood etc. These patients are not hypochondriac as they know that they are purposely faking the disease to gain attention or sympathy.

Suspicion should arise if symptoms appear dramatic but inconsistent with medical history or change once treatment has begun, or presence of symptoms only when the patient is alone or not being observed. Some patients have multiple surgical scars and are promptly willing to have medical tests, procedures or even surgeries.

Its a psychological disorder and need to be treated accordingly, though hard to treat.