Source: Annual Congress 2012 - The good clinical practice: useful case report

Abstract

Hemoptysis is a serious symptom in early childhood and further investigation may be required in some cases. Munchausen syndrome by Proxy (MSBP) must be kept in mind particularly when suspicious behaviors of the supervisors are observed.
Case 1: A thirteen-month-old boy was admitted with recurrent hemoptysis. He was hospitalized because of persisting symptoms for four months, however no reason was found and he was subsequently discharged. Detailed history revealed that hemoptysis had occurred only in times when he was alone with his mother. Despite comprehensive diagnostic evaluation including laryngoscopy, Computerized Tomography, bronchoscopy and endoscopy, no definitive etiology was diagnosed. During his hospitalization, the mother reported new bleedings of the child and blood stained clothes were noticed. Examination of security footage revealed that the mother was sneakily obtaining the blood samples of another patient and deceiving medical staff.
Case 2: An-eight-month old girl was admitted with a history of having vomited blood for two months. Reluctance of her mother was noticed by the physician during history taking. Upper endoscopic investigation revealed linear hemorrhagic lesions at pharynx and tonsils. No definitive etiology was diagnosed despite comprehensive investigations. During hospitalization, the doctor witnessed that her mother was injuring the child with her finger and making her bleed. She was warned about security footage of the room and her complaints resolved spontaneously.
Munchausen syndrome by proxy is an unusual and difficult to identify cause of child abuse. It must be taken into consideration particularly in conditions with secondary gain of family members.

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Citations should be made in the following way:
S.T. Yavuz, G. Cinel, U. Ozcelik, E. Yalcin, D. Dogru, N. Kiper (Ankara, Turkey). Munchausen syndrome by proxy presenting as unexplained hemoptysis: A report of two cases. Eur Respir J 2012; 40: Suppl. 56, 3500

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