Case history
Case history #1
A 30-year-old woman presents to hospital complaining of left flank pain for the past week with no other associated symptoms. She describes the pain as sharp, stabbing, and scoring 10 out of 10 in severity, although she had appeared comfortable while sitting in the waiting room. She reports that her sister has "just been taken off life support last week" and that her mother and brother have both also recently died. Her physical examination, including a pelvic examination, are normal. A social worker is asked to assist in linking the patient with community resources, but the patient refuses to give permission for the social worker to contact the family to help coordinate care.
Case history #2
A 39-year-old altruistic partial liver donor is admitted to hospital with a mixed aerobic bacterial wound infection 5 weeks after the transplant operation. Over the next several months she is re-admitted to hospital 3 times with recurrences of infection, each time with a different pathogen growth on culture. On further investigation and review of previous medical records, it is discovered that this patient has a previous history of complicated wound infections after knee surgery and a tumour removal.
Other presentations
Case reports from the literature demonstrate the breadth of presenting symptoms. Munchausen syndrome is a subtype of factitious disorder that was first described by Richard Asher in 1951.[2] In this extreme form the patient presents with dramatic tales of travel and acute illness, often attracting significant attention from hospital staff. As the story unfolds, the patient is found to have been to many different hospitals under aliases and with multiple complaints, often leaving against medical advice when it becomes clear that the symptoms are fabricated. The patient may have multiple scars from unnecessary laparotomies, perhaps even inducing unintentional complications, such as bowel obstructions. Although Munchausen syndrome is the most dramatic presentation of factitious disorder, most cases are less severe, with patients forgoing aliases, seeing physicians within one healthcare system, and receiving multiple hospital admissions for the same problem. Often, these patients have been given a diagnosis of a condition at some point that, in retrospect, was fabricated.[3]
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