Abstract
IntroductionLimb subcutaneous emphysema secondary to a Munchausen syndrome represents a rare and severe entity because it involves the functional prognosis of the limb and vital prognosis of the patient.Case presentationWe report the case of an 18-year-old Moroccan woman patient who presented to our hospital with a subcutaneous emphysema of the shoulder girdle and the right arm, caused by our patient. Treatment was aggressive, with a wide surgical debridement, parenteral antibiotic therapy and hyperbaric oxygen therapy. The results have been favorable.ConclusionsThe correlation of anamnestic data and clinical and para-clinical exams were essential for the diagnosis of Munchausen syndrome in this case. In this regard, we report a rare case of subcutaneous limb emphysema secondary to Munchausen syndrome.
Highlights
Limb subcutaneous emphysema secondary to a Munchausen syndrome represents a rare and severe entity because it involves the functional prognosis of the limb and vital prognosis of the patient
Munchausen syndrome is a factitious disorder that involves falsification of psychological or physical signs or symptoms caused entirely by the patient themselves, in a clear state of consciousness, in order to play the role of a sick person
The criteria for the diagnosis of factitious disorders are found in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision (DSM-IV TR) [2]
Summary
Munchausen syndrome is a factitious disorder that involves falsification of psychological or physical signs or symptoms caused entirely by the patient themselves, in a clear state of consciousness, in order to play the role of a sick person. We report a case of Munchausen syndrome revealed by subcutaneous emphysema of the shoulder region and the right arm, which required an aggressive management. The results of the bacteriological sampling were sterile She received post-operative sessions of hyperbaric oxygen therapy at the rate of one session of 45 minutes per day for 10 days, and daily care in the operating room. The quarrelsome and aggressive nature of our patient, her difficult relationship with the caregiver, records of her consultation for the same symptoms in four other hospitals, a lack of biological and clinical signs, and her inability to provide an explanation for the presence of the needle and the swelling in her right arm made us suspicions about the possibility of a factitious disease. Her psychiatric report stipulated that the act of self-injection of the needle and her need to draw
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