Where Reality and Fantasy Collide—Prolonged Fever to Munchausen Syndrome by Proxy

Background: Munchausen syndrome by proxy (MSBP) or factitious disorder imposed on another (FDIA) is a bizarre psychiatric entity, consisting of the fabrication of symptoms and alteration of laboratory tests by a caregiver. It is considered a serious form of child abuse. Alarm signs are frequent medical visits and strange symptoms that are never objectified during hospitalization. Methods: This case sets a bright light on how difficult the diagnosis and management of FDIA is and the severe consequences this disease has on a defenseless child. Results (Case report): A boy who is 3 years 8 months old first presented to our department in October 2022 for prolonged fever. We ruled out infections, malignancies, and autoimmune diseases. The patient kept coming back once every fortnight for the same reason-fever, every time associating it with something in particular and new-from painful joints to hemorrhagic complaints. Interestingly, with every new visit, the patient's medical history became more complex. The mother also developed an attachment relationship with the medical staff. During a 4-month period of repeated admissions, the child's symptoms were never objectified throughout hospitalization, and never consistent with the declared symptoms and test results. When the physician's attitude changed from empathic to distant, she never came back for check-ups. Conclusions: A pediatrician's work largely depends on good communication with the parents. When there is no medical explanation for declared symptoms, one might question the merit of the story

Child abuse · Crying · Disease · Factitious disorder · Fantasy · Fever of unknown origin · Medical emergency · Medical history · Munchausen syndrome · Poison control · Proxy (statistics · Psychiatry · Suicide prevention · Child Abuse and Related Trauma · Child Abuse and Trauma · Homicide, Infanticide, and Child Abuse · Medicine · Pediatrics · Surgery

• Munchausen by Proxy Syndrome

  Open Access•Dilşad Foto Özdemir, Siddika Songül Yalçin et al.•Journal of Family Violence•2015

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