Münchausen Syndrome as an Unusual Cause of Pseudo-resistant Hypertension: A Case Report.

Małgorzata Kobusiak-Prokopowicz,Maria Kała,Jerzy Leszek,Andrzej Mysiak,Bogdan Tokarczyk,Anna Marciniak

doi:10.1515/med-2019-0094

Małgorzata Kobusiak-Prokopowicz, Maria Kała + Show 4 more

Open Access

https://doi.org/10.1515/med-2019-0094

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Abstract

Münchausen syndrome can be characterized by simulated illness, pathological lying and wandering from place to place (the patient typically presents to numerous hospitals). Individuals with elevated blood pressure due to non-adherence to medication have the so-called pseudo-resistant hypertension.A 45-year-old woman was admitted to hospital on an emergency basis because of a hypertensive crisis. Despite combination antihypertensive treatment, normalization of blood pressure was not achieved and a device to produce a therapeutic arteriovenous fi stula was implanted. Aft er the procedure, a signifi cant increase in pulmonary artery pressure was observed and closure of the fistula was performed by implantation of the stent graft . The suspicion was raised that the patient had not been taking her prescribed medications. Therefore, blood samples were taken and the serum was analyzed for presence of the prescribed drugs (atorvastatin, bisoprolol, chlorthalidone, clonidine, doxazosin, furosemide, nitrendipine, oxazepam and valsartan). The results confirmed suspected failure of the patient to take the prescribed medications.Münchausen syndrome is usually first suspected when inexplicable laboratory test results are noted. To our knowledge, this is the first reported case of Münchausen syndrome with pseudo-resistant hypertension leading to the implantation of a device to produce a therapeutic arteriovenous fi stula.

Highlights

Münchausen syndrome can be characterized by three features: simulated illness, either physical or psychiatric; pathological lying; and wandering from place to place—the patient typically presents to numerous hospitals
The study by Jung et al, which was designed to identify the degree of medication adherence in patients with resistant hypertension, showed that 53% of patients with uncontrolled hypertension were non-adherent to prescribed drugs when assessed by toxicological urine analysis
Pseudo-resistant hypertension would need to be excluded by an established method of assessing adequate medication adherence with standardized measurements and 24-h ambulatory blood pressure monitoring

Summary

Introduction

Münchausen syndrome can be characterized by three features: simulated illness, either physical or psychiatric; pathological lying (pseudologia phantastica); and wandering from place to place (known as peregrination)—the patient typically presents to numerous hospitals. In this syndrome, the affected person exaggerates or creates illnesses in themselves to gain examination, treatment and sympathy. Patients with Münchausen syndrome often present with dramatic symptoms of somatic diseases; the doctor will only begin to consider the psychological basis of the disease after a multi-stage diagnosis This happens when, contrary to physical examination, there is little or no organ damage [4]. Münchausen syndrome has been recently included in the list of causes of pseudo-resistant hypertension [7]

Case presentation

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