Syndrome de Munchausen

Syndrome de Munchausen

In my many years as a physician, I have seen many unusual cases. Some of these have been very difficult to diagnose or treat. Some of the most challenging ones have been those thought to have the Munchausen’s syndrome. I say ‘thought to have’, because this is a difficult diagnosis to confirm.

I remember one patient who was a man admitted with an infection in his blood. He was in his 50’s with no major medical problems. I was in my fellowship training in Infectious Disease at that time. We were called to see him in Consultation, because the bacteria growing in his blood was very unusual.

He had no risk factors for developing a blood infection. I took a detailed history on him and we could not find a reason for the bacteria to get into his blood.  While the bacteria was unusual, it was fairly sensitive to antibiotics. We treated him with intravenous antibiotics and the infection resolved and he was discharged.

A few months later, I was back on service, and we were consulted on the same patient. He had developed another infection of the blood. This was a different bacterium, but also very rare and unusual. We did a detailed work up on him, including an exhaustive history, but could find no cause. He was treated with antibiotics and recovered and was discharged.

In the next several months, he was admitted two more times. Each time he had a blood infection, but with a different bacterium. He responded well to antibiotics. On his fourth admission, he told me that these repeated infections were making it difficult for him to work and he had applied for disability.

My attending physician sat down with me to re-evaluate this patient. He had no risk factors for repeated infections. The bacteria involved were very unusual, but also different each time. My attending asked me if I noticed anything in common with his repeated infections. The only thing I saw was that these were unusual infections from different bacteria that we rarely saw.

He then pointed out to me that all these bacteria can be found in stools. How would they get into his blood, I asked? His theory was that our patient was injecting himself with toilet water, in an attempt to get disability. But how are we going to confirm that, I asked? Let us ask him he replied.

We went back to our patient and asked him. He became very defensive and angry. He told us that if we do not have the ability to diagnose and treat him, then he prefers to be discharged. We did treat him with antibiotics and cleared the infection. He was discharged and was not seen again in our hospital. We were never able to confirm a cause of his repeated infections.

While we were not able to prove it, we thought that the above case was an example of Munchausen’s syndrome. This basically means a disorder imposed on one’s self. The incidence and the reasons for this are often not clear as patients will deny it when confronted. The presence of this condition usually points to a deeper underlying psychological condition or some kind of secondary gain.

Baron Von Munchausen was a fictional character created by a writer in Germany in the 1700’s. It was based on the real life exploits of Hieronymus Karl Friedrich von Munchhausen, a German nobleman in those days, who was famous for his tall tales.

Baron Von Munchausen riding a cannon ball.

Thus fabricating symptoms or imposing a condition on one’s self used to be called Munchausen’s syndrome (or Syndrome de Munchausen in French). The modern term for this condition is now ‘Factitious Disorder’, but the term Munchausen’s is still commonly used.

As for our patient, I do not know what happened to him. I hope he is doing well today.