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

Abstract

Hemoptysis is a serious and sometimes life-threatening symptom that requires broad evaluation, including invasive procedures.Neverthless in a group of patients, the cause of hemoptysis may not be elucidated despite extensive investigations.Factitious hemoptysis is a manifiestation of Munchausen syndrome that describes a group of patients who intentionally produce or feign symptoms or disabilities; and it must be kept in mind in the differential diagnosis of unexplained hemoptysis.Here we report 5 patients diagnosed as Munchausen syndrom whose complaints were hemoptysis.
PATIENTS: Five patients (1 male,4 females), median age 15 (10-16,5), described hemoptysis occuring with cough or sputum.Symptom duration was 6 (1-24) months.They had not hematemesis or melena. Despite having hemoptysis everyday, or once in 2 or 3 days, hemoglobin values varied between 12,2-14,8 (median 13,2) g/dL. Chest x-rays, computed tomography of thorax, laryngoscopy, flexible bronchoscopy, hematological survey related with bleeding diathesis were normal in all patients. Accompanying psychiatric problems were determined in two patients with detailed history. In one patient, detailed physical examination revealed multiple crusted and bleeding bitched lesions on the buccal mucosa. One patient brought us 3mL red fluid in a plastic cup as her bloody cough, but it was cherry juice. The other patient had problems with her school and family; and her hemoptysis was existing when she had bad notes at school.
Munchausen syndrome should be considered in the differential diagnosis of hemoptysis of unclear etiology, especially when accompanied by changing symptoms and in patients with a calm manner despite dramatic complaints.

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G. Cinel, S.T. Yavuz, U. Ozcelik, E. Yalcin, D. Dogru, N. Kiper (Ankara, Turkey). A rare cause of hemoptysis: Munchausen syndrome. Eur Respir J 2012; 40: Suppl. 56, 3510

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