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Correspondence

Indian Pediatr 2014;51: 1019-1020

Factitious Bleeding Disorder in a Child: An Unusual Presentation of Munchausen Syndrome


Meenu Pandey and *Ashu Sawhney

Jaypee Hospital, Sector 128, NOIDA, UP, India.
Email: * dr.ashusawhney@gmail.com
 

   


Munchausen Syndrome (MS) is a psychiatric disorder characterized by feigning of symptoms of some physical or mental disorder, by patients [1].

A nine-year-old girl presented with complaints of bleeding from multiple sites. Ten days prior to presentation, the child had complained to her parents of severe pain in the right breast followed by bloody discharge from right nipple. Similar bleeding was also seen by the parents in other places, including eyes (Fig. 1), nose, ears, oral mucosa and umbilicus. The ‘bleeding’ consisted of few drops and was self-limiting. Rest of the history was unremarkable and there was no obvious psychological stressor. Her vital parameters were stable and the systemic examination did not reveal any abnormal findings.

Fig. 1 Patient showing factitious bleeding from the right eye.

Blood counts, including hemoglobin, platelet count and peripheral smear were within normal ranges. Liver function tests and coagulation profile were normal. Urine and stool microscopy did not reveal any red blood cells or occult blood. Screening test for Factor XIII levels was normal and platelet aggregation studies showed normal aggregation with ADP, AA, Collagen and Ristocetin.

It was explained to the parents that there was a discrepancy between their child’s clinical profile and her investigation reports. In due course of time, the child revealed to the clinician and the parents that she had been applying her mother’s liquid vermillion to fake bleeding. Thus, she was diagnosed as a case of Munchausen Syndrome. She was referred for psychiatric treatment, which the parents refused.

Munchausen Syndrome is an extreme form of factitious disorders, wherein the sufferer simulates illness, to assume patient role [1]. It is characterized by multiple outpatient visits or hospitalizations [2]. Typically, sufferers lie deliberately and may consume drugs like insulin, vitamins, warfarin to produce adverse effects like hypoglycemia, and bleeding symptoms [3]. It is uncommon in children and should be suspected if there is a discrepancy between symptoms and signs/investigation results.

Acknowledgements: Dr Piyush Chandel, Dr Mukesh K Singh and Dr Narender Tejwani.

References

1. American Psychiatric Association. In: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994:471-2.

2. Asher R. Munchausen’s syndrome. Lancet. 1951;1:339-41.

3. Guggenheim FG. Somatoform disorders. In: Sadock BJ, Sadock VA, editors. Kaplan and Sadock’s Comprehensive Textbook of Psychiatry. 7th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2000:1514-8.

 

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