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PubMed1983

[Factitious fevers as a cause of prolonged fevers. Apropos of 5 clinical cases].

Among the numerous causes of prolonged fever of unknown origin, the factitious fevers are frequently considered last after much diagnostic and therapeutic effort. Five observations of factitious fever are presented including 2 cases of thermometer manipulation in men aged 45 and 80. The latter patient is the oldest in whom such a case has been reported. In the first case the prolonged fever led to exploratory laparotomy with splenectomy followed by antilymphoma chemotherapy before the thermometer manipulation was discovered. This patient had previously been treated successfully for stage Ib Hodgkin lymphoma. In the other case hospitalization had lasted several weeks, and much antibiotic and steroid treatment had been administered, before the manipulation was suspected. A third case of thermometer manipulation was observed in a 57-year-old woman who had been presenting with factitious symptoms for over 10 years. Two other cases of factitious fever due to self-induced infections have been observed in two young women aged 23 and 27, both in paramedical professions. These self-induced infections led to polymicrobial bacteremia, exploratory laparotomy and hemicolectomy in one case, and to probable bacterial meningitis in the other. Certain aspects of these cases agree well with the diagnostic criteria of factitious fever described in the literature. We feel it is important to recognize this cause of febrile states, even if there is an apparent etiology, in order to avoid much vain investigation and prolonged hospitalization.

Adult↗
PubMed1983

[Self-induced giant lymphedema of the hand (sinistrosis)].

The authors describe a case of a self-caused giant lynphoedema of the hand. The authors underline the importance of hospitalization for the diagnosis, also to be able to exclude any form of organic pathology. They suggest the utility of a decompressive operation of the lynphatic circulation by a little fasciatomy at the root of the forearm, in order to avoid the application of a lace on the wound of the forearm root. Of great importance is furthermore to close the limb into a plastered apparatus for the same purpose.

Exercise Therapy↗
PubMed1983

Improving accuracy in the diagnosis of Alzheimer's disease.

During a longitudinal study of outpatients with early Alzheimer's disease, several patients were found to have been incorrectly diagnosed as having a progressive dementia; case histories of three such patients are presented. Certain objective tests of dementia (The Extended Scale for Dementia, Mini-Mental Status, etc.) and language functions (The Porch Index of Communicative Ability), as well as The London Psychogeriatric Rating Scale (completed by a family member), have been found useful and are described briefly. The importance of reevaluating demented patients to document the course of their illness is emphasized to improve the accuracy of diagnosis in suspected cases of Alzheimer's disease.

Alzheimer Disease↗
PubMedDate not supplied

Factitious asthma.

Explore the source record for details and available documents.

Adult↗
PubMed1983

Factitious vesicocutaneous fistula: an enigma in diagnosis and treatment.

A case report of a patient with a recurrent factitial vesicocutaneous and a tensor fasciae latae musculocutaneous flap were employed in reconstruction. Difficulty in diagnosis and treatment of this patient with factitial disease is emphasized. Excessive hospitalization and cost reflect these difficulties. A life-threatening disease was modified by planned reconstruction coordinated with antidepressant medication and psychotherapy. Treatment centered on avoiding insight and maintaining denial ASA defense mechanism. The transference of self-mutilation in the suprapubic region to the donor thigh was most important in this patient's survival.

Adult↗
PubMed1983

Factitious hypoglycemia: an unusual clinical picture within Von Münchausen's syndrome.

Two cases of hyperinsulinism from insulin self-administration are described, both patients being admitted to hospital with a diagnosis of insulinoma. In the first case, the diagnosis was clarified after a left pancreatectomy elsewhere, thanks to the discovery of a bottle of insulin. In the second case, the diagnosis was confirmed by the measurement of C-peptide during a hypoglycemic attack. The simultaneous sharp decrease in glucose levels, an exceptional increase in insulinaemia and a reduction or disappearance of serum C-peptide is indicative of this particular type of hyperinsulinism. The two cases described here were remarkably similar. Apart from the most common features, both reported a severe hypoglycemic syndrome of recent onset; negative tolbutamide and calcium tests; a frequent relapse shortly after glucose administration.

Adult↗
PubMed1982

Factitious illness in gynecology.

Factitious or self-induced illness has rarely been mentioned in gynecologic literature. Described herein are 4 nonpregnant women, 3 of whom had vaginal bleeding of unknown origin and 1 who had recurrent fevers and an acute abdomen. In gynecologic practice, factitious illness should be suspected whenever a patient presents with a protracted illness that has eluded diagnosis. Furthermore, the index of suspicion for factitious illness should be high whenever a patient has an abnormal psychiatric history or has worked in a paramedical field.

Abdomen, Acute↗