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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2012 August;171(4):483-9


language: English

Bleeding in Munchausen syndrome

Girolami A., Allemand E., Berti De Marinis G., Pietrogrande F.

Department of Medical and Surgical Sciences, University of Padua Medical School, Padua, Italy


Aim. Munchausen syndrome is considered as a part of Factitious disorders characterized by predominantly physical signs and symptoms. Most cases are first seen by general practitioners or internists and only subsequently by psychiatrists. Self induced bleeding may be part of the Munchausen syndrome.
Methods. Two female patients, aged 19 and 20, presented with peculiar bleeding manifestations. The first patient with ecchymotic subcutaneous nodules of abdomen and limbs. The second with recurrent and alternating bleeding from the nipple of both breasts. The management of the two cases required extensive clinical and laboratory investigation and also invasive procedures (biopsies and, in the second patient, bilateral mastectomy). The suspicion of the factitious origin of the symptoms arose, in the first patient, because only parts of the body reachable by hand were involved and in the second patient because bleeding from the nipples occurred only in concomitance with menstruation.
Results. The two cases here exposed are typical examples of the complexity of the diagnostic problems involved in the management of these patients. Several medical conditions such as: congenital and acquired bleeding diathesis, panniculitis, endometriosis, endocrine dysfunction, breast cancer, etc. had to be ruled out before reaching the correct diagnosis.
Conclusion. Once the suspicion of a Munchausen syndrome is formuled, these patients should be closely monitored. Nurses and family members may be very useful in this regard, even though the latter tend to minimize events. Extensive psychiatric treatment is essential since it was beneficial in both cases. At present both patients lead a normal life.

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