Diagnosing medical conditions is not easy. Patients may present with unexplained symptoms that point to common problems as easily as rare or poorly understood problems. They can forget important things and sprinkle in irrelevant details.
But there are rare cases of pure deception. This was the case of a woman who was seen at Massachusetts General Hospital for severe pain and cramping. Female case recordwas published this week in the New England Journal of Medicine, documenting a thorough investigation of her dramatic condition. , led to confusion.
It started when a woman was worried about abdominal pain, jerking movements of her right arm and leg, confusion, agitation, a rash on her chest, and a dislocated jawbone when she visited another hospital. She told doctors at the hospital that she had a history of acute intermittent porphyria and that her symptoms were consistent with flare-ups of her previous condition.
Porphyrias are rare diseases caused by genetic mutations that are usually inherited. This mutation affects enzymes involved in converting compounds called porphyrins and porphyrin precursors to heme. Hemoglobin is an iron-containing red protein in the blood that is involved in the transport of oxygen. In people with porphyria, heme precursors accumulate, causing disorders such as abdominal pain, arm and leg pain, paresthesia, weakness, and tachycardia.
The woman was admitted to the first hospital and began receiving treatment. However, she was transferred to General Hospital in Massachusetts due to lack of hemin, the standard treatment for her porphyria.
So she told her doctors a similar story and they started treating her with hemin and other medications including morphine for pain. They noted on her record that she looked older. Her maternal grandmother had the condition and her one of her seven siblings was a mute carrier. She also said that although she was born in New England, she moved to the UK 15 years ago and was only in the area to visit her family.
strange thing
Over the next two days, strange things began to pile up. Her symptoms did not improve even though doctors gave her standard treatment for porphyria, and her PBG and porphyrin levels in her urine (usually elevated in porphyria) ) was normal.
Doctors began to suspect that porphyria was behind the woman’s symptoms. They thought drugs or toxins, such as lead poisoning, were causing some of the symptoms. Withdrawal symptoms from discontinuing morphine prior to her admission were also considered. However, the woman’s symptoms were also not improved by morphine, which ruled out that possibility.
Meanwhile, something even stranger happened. For one thing, doctors were unable to verify the identity of the woman, nor were they able to identify any family members or friends of hers who could verify her identity or vouch for her experience.
She told a doctor that she had been evaluated at a blood clinic in the UK, but when the doctor contacted the clinic, she was told that there was no record of a patient with the same name. “We received multiple calls from hospitals in the United States requesting health information about female patients with a similar history of acute intermittent porphyria. Patients usually had different names but the same date of birth. He said.
Pieces were put together and a diagnosis was made: Factitious disorder.
Physicians report that induced disorder is characterized by deception about false illnesses and symptoms. It looks motivated. Many patients diagnosed with this condition describe substantial trauma histories.
Showdown
A multidisciplinary team of medical, hematology, and psychiatric physicians met with the woman. They presented their findings, including information from a UK clinic, and her concern that she was deceiving them.She chose to leave the hospital, and she was discharged without taking medication. bottom.
On the same day, a woman with a different name showed up in the emergency department of an affiliated hospital to be treated for a dislocated ankle from a dirt bike fall. Four days later, the woman returned to the hospital with a recurrence of acute intermittent porphyria and was admitted to the intensive care unit. A hematologist and Massachusetts general who worked at the hospital recognized the patient’s symptoms. A photo of the woman in the first case matched a woman using a different name. Again, a multidisciplinary team of doctors met her and confronted her concerns of deception. She chose to leave the hospital again and she was discharged without medication.
But things didn’t end there, doctors report:
In the months that followed, five identities were discovered at this hospital and affiliated hospitals in New England. In addition, the hospital received a call from two of her other hospitals in the mid-Atlantic region requesting additional information on a woman with similar details to the patient’s medical history.
Doctors note that this woman is not uncommon among cases of induced disorder. Up to 77% of patients never admit to their deception and instead walk away from their doctor. Over 60% decline psychiatric follow-up her care, but treatment has shown efficacy for this condition.
“Ultimately, the prognosis is poor given the increased morbidity and mortality associated with feigning illness and undergoing unnecessary medical or surgical interventions,” the doctors concluded. rice field.
