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PubMedDate not supplied

Utility of plasma free metanephrines in diagnosis of factitious pheochromocytoma.

OBJECTIVE: To report a case of epinephrine-induced factitious pheochromocytoma in a young woman with a past medical history of Conn's syndrome. METHODS: We present a case report with clinical and laboratory details, review related reports in the literature, and demonstrate the usefulness of plasma free metanephrine levels in facilitating the diagnosis of factitious pheochromocytoma. RESULTS: A 34-year-old woman was admitted to our hospital for confirmation and localization of an occult pheochromocytoma. After thorough investigation, we discovered that the patient was surreptitiously injecting epinephrine in order to induce symptoms and signs consistent with a pheochromocytoma. Analysis of the patient's biochemical profile during and between her catecholaminergic crises revealed plasma epinephrine and free metanephrine levels that would be highly unusual for a patient with a pheochromocytoma. CONCLUSION: This case illustrates the utility of implementing the ratio of plasma epinephrine to free metanephrine levels in distinguishing factitious from organic pheochromocytoma.

Adult↗
PubMedDate not supplied

Fatal factitious Cushing's syndrome and invasive aspergillosis: case report and review of literature.

OBJECTIVE: To present the first reported fatality from invasive aspergillosis related to factitious Cushing's syndrome. METHODS: We summarize the history, clinical findings, and outcome in a patient ultimately found to have factitious Cushing's syndrome. In addition, the dangers of fulminant infections in untreated Cushing's syndrome are analyzed relative to molecular and immunologic aspects, and the pertinent literature is reviewed. RESULTS: A 33-year-old female medical transcriptionist was admitted with rapidly fatal septic shock and diffuse pulmonary infiltrates. Autopsy revealed invasive pulmonary aspergillosis and atrophied adrenal cortices. On subsequent investigation, hidden bottles of prednisone were found throughout the patient's home. Factitious Cushing's syndrome has rarely been described and can be a difficult diagnosis to establish, but it is important to recognize this condition because of its potentially drastic consequences. Our understanding of the mechanism of immunosuppression from glucocorticoids related to the increased risk of invasive fungal infections is evolving. Factitious illness can manifest in numerous ways; therefore, health-care providers in all specialties should be familiar with epidemiologic, diagnostic, and treatment considerations for this illness. CONCLUSION: Endocrinologists should be aware of the possibility of factitious Cushing's syndrome because it can be an elusive and ultimately fatal condition.

Adult↗
PubMed2006

Dermatitis artefacta in soldiers.

BACKGROUND: Dermatitis artifacta is not an uncommon disease in military settings. Soldiers may intentionally produce skin lesions to achieve sick leave from military duties. The aim of this work was to describe a series of soldiers with dermatitis artifacta. METHODS: A prospective study was conducted among soldiers of the Israel Defense Force. RESULTS: Fourteen soldiers from the Israel Defense Force were included in the study. There were 13 men and one woman. The ages of the patients ranged between 19 and 26 years. For all patients, dermatitis artifacta was characterized by the acute appearance of a pruritic rash located on readily accessible areas of the limbs and abdomen. The rash was associated with systemic symptoms for 12 (85.7%) of 14 patients. None of the patients admitted to intentionally inflicting the skin lesions. The rash consisted of erythematous patches with numerous papules and pustules arranged in a linear pattern. All patients were treated with topical corticosteroids, four patients were treated with antibiotics, and three patients were treated with systemic corticosteroids. For all patients, the eruption resolved completely within 1 to 3 weeks. CONCLUSIONS: In the context of soldiers standing to gain sick leave by assuming the sick role, dermatitis artifacta can be reliably diagnosed by noting the characteristic location and morphological features of the skin lesions.

Adrenal Cortex Hormones↗
PubMed1988

Drug purpura due to surreptitious quinidine intake.

Three patients had recurrent episodes of thrombocytopenia that resembled drug purpura, but the drug history in each case did not support the diagnosis. Although the patients specifically denied taking quinidine, serologic testing with this drug was done because the patients had access to it, and it is the commonest cause of drug purpura. Highly specific quinidine-dependent antiplatelet antibodies were found in the sera of all three patients. After being informed of the laboratory findings, the patients have had no recurrences of purpura. Serologic tests for quinidine- or quinine-dependent antibodies can help elucidate some obscure cases of purpura that may be self-induced.

Aged↗
PubMed1988

Factitious hypoglycemia due to surreptitious administration of insulin. Diagnosis, treatment, and long-term follow-up.

Ten patients had factitious hypoglycemia due to surreptitious insulin injections diagnosed and were followed for up to 15 years (median, 5 years; range, 2 months to 15 years). When available, demonstration of anti-insulin antibodies was the most helpful diagnostic test. Decreased plasma C-peptide levels corroborated the diagnosis. Young women (nine of ten) with knowledge of the medical profession or relatives with diabetes mellitus predominated in the sample. Five of the patients had a history of insulin-requiring diabetes mellitus. Two patients eventually committed suicide despite the best efforts at therapy. Only three of ten patients made a successful transition into productive life after the diagnosis of factitious hypoglycemia was established. Factitious hypoglycemia remains a difficult diagnosis to make, and the long-term outcome after the diagnosis is established is unpredictable. All efforts have to be made to confirm the diagnosis before the patients are approached. The confrontation is to be made by an experienced team of health care professionals who have gained the patient's confidence through an understanding but firm manner. Long-term therapy must be planned and initiated before the patient's discharge.

Adult↗
PubMed1994

Factitious HIV infection: the importance of documenting infection.

OBJECTIVE: To examine possible causes for factitious human immunodeficiency virus (HIV) infection among patients in an HIV clinic. DESIGN: Retrospective chart review, a case-control study, and a survey of local hospital practices for documenting HIV infection. SETTING: Clinical acquired immunodeficiency syndrome (AIDS) program at a municipal hospital. RESULTS: Seven patients with self-reported, undocumented HIV infection were identified as HIV seronegative after a mean of 9.2 months of care in our clinical AIDS program. The median CD4 count for these patients was 740 cells/mm3; 6 patients had a history of illicit narcotic use and clinical symptoms consistent with HIV disease. Compared with 70 randomly selected controls from HIV clinics, patients with factitious HIV infection had higher CD4 counts (difference, 519 cells/mm3; P < 0.001) and were more likely to have an HIV-infected sexual partner (odds ratio, 15.0; P = 0.005) and a history of a suicide attempt (odds ratio, 9.8; P = 0.02). Known cases of alleged HIV infection have occurred at 8 of the 10 other local hospitals surveyed. However, only 1 of the 10 hospitals routinely documented HIV infection in patients before initiating care. CONCLUSIONS: Limitations of the current serologic tests for HIV, the use of anonymous HIV testing, and recent reports of factitious HIV disease or immune deficiency syndromes that may mimic AIDS underscore the need for clear documentation of HIV infection before medical care is started.

Adult↗
PubMed1999

Diagnostic clues to dermatitis artefacta.

We report a case of dermatitis artefacta in a 36-year-old man who had progressive, nonhealing ulcers and swelling of his right arm. The lesions spared two tattoos. In addition, our patient had several of the classic features of dermatitis artefacta. We outline more than a dozen diagnostic clues that may help the clinician faced with this difficult problem.

Adult↗