Munchausen syndrome mimicking refractory subcutaneous abscess with bacteremia, diagnosed by repetitive element sequence-based polymerase chain reaction: a case report View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-09-12

AUTHORS

Naoki Iwanaga, Kazuko Yamamoto, Takahiro Takazono, Tomomi Saijo, Yoshifumi Imamura, Taiga Miyazaki, Koichi Izumikawa, Yoshihiro Yamamoto, Katsunori Yanagihara, Akira Yasuoka, Hiroshi Mukae

ABSTRACT

BackgroundRapid diagnosis and appropriate treatment of Munchausen syndrome is important not only for the patient but also for health care workers because a delay in diagnosis can worsen patients’ clinical outcomes, and result in a substantial medical cost.Case presentationA young and previously healthy 24-year-old Japanese woman, a nurse, presented with complaints of refractory abscess on her left upper limb for 3 months. A physical examination on admission revealed low-grade fever and a subcutaneous abscess in her left forearm. Laboratory data suggested mild systemic inflammation and liver dysfunction, but no abnormalities of the immune system, including changes in the number of lymphocytes and neutrophils, neutrophil phagocytic capacity, and natural killer (NK) cell activity, were observed. A human immunodeficiency virus test was also negative. Multiple modalities, including positron emission tomography-computed tomography, failed to detect any cause and focus of infection except her left upper limb. Streptococcus mitis and Prevotella buccae were detected from the wound, but no microorganisms were detected in a blood culture. The cellulitis promptly resolved; however, exacerbation of the subcutaneous abscess with polymicrobial bacteremia repeatedly occurred unexpectedly. Because of this puzzling clinical course, the possibility of self-injury was finally suspected. Three syringes with needles, with a turbid liquid, were found in our patient’s bag. Enterobacter cloacae and Enterococcus faecalis were detected in the liquid, and an analysis via repetitive element sequence-based polymerase chain reaction determined that Enterococcus faecalis in the wound and syringe contents were genetically identical. She was diagnosed as having Munchausen syndrome and treated with the collaboration of a psychiatrist. She finally confessed that she had injected her own saliva and toilet water into the drip line and wound.ConclusionsThis case report is valuable in that it is the first case in which this syndrome was diagnosed by a genetic method. Munchausen syndrome should not be neglected as a possible cause of refractory and recurrent infection. More... »

PAGES

287

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13256-019-2212-7

DOI

http://dx.doi.org/10.1186/s13256-019-2212-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1120971079

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/31511062


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111 phagocytic capacity
112 physical examination
113 polymerase chain reaction
114 polymicrobial bacteremia
115 positron emission tomography-computed tomography
116 possibility
117 possible causes
118 psychiatrists
119 reaction
120 recurrent infections
121 refractory
122 refractory subcutaneous abscess
123 repetitive element sequence-based polymerase chain reaction
124 report
125 saliva
126 subcutaneous abscess
127 substantial medical costs
128 syndrome
129 syringe contents
130 syringes
131 system
132 systemic inflammation
133 test
134 toilet water
135 tomography
136 tomography-computed tomography
137 treatment
138 turbid liquid
139 upper limb
140 virus test
141 water
142 women
143 workers
144 wounds
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