Munchausen's syndrome in an 85-year-old man.

Abstract

To the Editor:—Munchausen's Syndrome is a rare form of factitious illness characterized by repeated hospital admissions for physical complaints and self-induced illness. Less than 50 cases have been reported in the medical literature, and to our knowledge, the oldest reported age for this disorder is 62 years.1 We report here a case of Munchausen's Syndrome presenting in an 85-year-old man. An 85-year-old man was admitted to the cardiology service to rule out a myocardial infarction. He was admitted to the hospital directly from the airport, where he had been complaining of acute chest pain. After several hospital days, a myocardial infarction was ruled out, but he continued to complain of chest as well as low back pain. Intramuscular injections of meperidine were required for pain control. The patient claimed to be a neurosurgeon who had retired 13 years earlier. He said he was in the Los Angeles area to settle his mother's estate. He gave a history of previous myocardial infarctions in 1962 and 1973 as well as a history of a cerebral vascular accident in 1973. He had had a gastrectomy for ulcer disease. His past medical history was also remarkable for a long history of smoking, but he stringently denied any use of alcohol. His medications on admission included nifedipine, methyldopa, and Dyazide. He said that his plans following discharge would be to go to a nursing home or a motel for a week so that he could complete his “business.” The patient was reluctant to share any details of his prior medical care or family history. However, he did claim to have been cared for by Paul Dudley White. Physical examination revealed an obese elderly man with cigarette stains on his lips and hands. He was cantankerous and angry during the interview and examination, and stated that he would be able to take care of himself and didn't need the examiner's help. He was alert and oriented, and his cranial nerves were intact. He used a cane for walking; he claimed to be very weak in the left upper extremity, yet he was able to move about independently without difficulty. Persistent questioning revealed that he had been recently hospitalized at a nearby VA hospital for similar complaints and had sought admission to the VA nursing home. Subsequent investigation led to the discovery of two other recent hospitalizations at local private hospitals. Clearly this man presented with unusual elements in his past medical and work history, both of which seem farfetched. It is our impression that one of his motivations for staying in the hospital was to receive pain medication. As in other cases of this disorder, he became defensive when caregivers inquired about details of his past history. He eventually left the hospital against medical advice. Because these patients tend to wander from hospital to hospital, no long-term follow-ups have been carried out to characterize the outcome of this syndrome. Stern2 has pointed out that many patients have been described in the literature more than once; one patient was listed 16 times. It is instructive to note that even in the eighth decade patients may continue this behavior, which not only heavily drains health care dollars but also adds redundancy to our medical literature.