P01-296 - “I don’t Want to be a Patient”: Case Report on Munchausen's Syndrome

Abstract

Objectives

The Munchausen's Syndrome, first described by the English doctor Richard Asher in 1951, refers to a factitious disorder present in patients who are repeatedly admitted in medical emergencies for apparent serious diseases and are looking forward to intensive medical care. The authors present a challenging case report, highlighting the importance of a thorough medical investigation before setting into Munchausen's Syndrome stigmatizing diagnosis.

Methods

The authors present a case studied in an Oncological Center, with emphasis on the medical data, diagnostic process, multidisciplinary approach, family-social-occupational implications and outcome. A review on Munchausen's Syndrome, using Medline database, focusing on the last decade publications on the subject, was carried out.

Results

The clinical presentation initially led to strong suspicion towards Munchausen's Syndrome, since it was an young adult, single, health related profession (doctor), with life event triggers (family and social isolation; affective rupture).With the on going diagnostic process, it ended out on an atypical presentation of Crohn's Disease. However, the stigmatizing label had already been set, adding psychological damage to the patient (adjustment depressive disorder).

Conclusion

From the Munchausen's Syndrome review in recent literature, the authors conclude that this rare diagnosis is even rarer on oncologic settings. It should always be an exclusion diagnosis, made after a careful medical screening carried on by an expert and multi-disciplinary team, which should include a liaison psychiatrist. The patient presented classical Munchausen's clinical profile, which can be misleading by it self, incurring into a misdiagnosis.