J Korean Orthop Assoc.  2018 Feb;53(1):76-79. 10.4055/jkoa.2018.53.1.76.

Munchausen Syndrome in Orthopedics

• Shim DM
• Woo YH
• Kim CS
• Jang BJ
• Park JS

• KMID: 2405403
• DOI: http://doi.org/10.4055/jkoa.2018.53.1.76

Abstract

Munchausen syndrome is a rare factitious disorder in which a person repeatedly and deliberately acts as if he or she has a physical or mental illness when he or she is not really sick. These patients distort their medical history, undergoing dangerous diagnostic and therapeutic procedures, often resulting in misdiagnosis. Management of this syndrome requires collateral history taking, sound clinical approach, exclusion of organicity, and addressing psychological issues. We report a 54-year-old female, who underwent orthopedic surgery 13 times. She was always unsatisfied with her surgical outcomes, and underwent additional surgical treatment of the shoulder, elbow, wrist, and knee joint. She repeatedly complained of joint pain, which was much more exaggerated than expected from her examination results. Therefore, we considered artificial arthrosis for a differential diagnosis of unclear arthrosis, and paid special attention when she exhibited odd behaviors.

Keyword

Munchausen syndrome; factitous disorder

MeSH Terms

Arthralgia
Diagnosis, Differential
Diagnostic Errors
Elbow
Female
Humans
Knee Joint
Middle Aged
Munchausen Syndrome*
Orthopedics*
Shoulder
Wrist

Figure

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  Figure 1 Patient underwent total knee arthroplasty on the left knee joint.

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  Figure 2 Patient even received neuroplasty on the left elbow joint.

Reference

1. Clarke E, Melnick SC. The Munchausen syndrome or the problem of hospital hoboes. Am J Med. 1958; 25:6–12.

2. American Psychiatric Association. Diagnostic and statistical manual-text revision (DSM-IV-TRim, 2000). 4th ed. Washington, DC: American Psychiatric Association;2000.

3. Huffman JC, Stern TA. The diagnosis and treatment of Munchausen's syndrome. Gen Hosp Psychiatry. 2003; 25:358–363.

4. Korantzopoulos P, Ntalas IV, Massis I, Goudevenos JA. Munchausen syndrome presented as recurrent syncope. Int J Cardiol. 2015; 184:424–425.

5. Baig MR, Levin TT, Lichtenthal WG, Boland PJ, Breitbart WS. Factitious disorder (Munchausen's syndrome) in oncology: case report and literature review. Psychooncology. 2016; 25:707–711.

6. Folks DG, Freeman AM 3rd. Münchausen's syndrome and other factitious illness. Psychiatr Clin North Am. 1985; 8:263–278.

7. Altınkaynak S, Ertekin V, Alp H, Fidan T. Munchausen's syndrome. Eurasian J Med. 2009; 41:126–128.