A case of munchausen syndrome by proxy: is it a misdiagnosis?

Abstract

Introduction

Child abuse is an area in Forensic Medicine where the diagnosis and management could be difficult. A deep history and close inward observation is a must where there is the slightest doubt of child abuse, in order to identify compounding factors and address accordingly. Here we report a case of repeated episodes of hematuria which was extensively investigated in three tertiary care hospitals revealing no cause, ultimately the mother being discovered as the culprit.

Case report

A three year old boy who was extensively investigated for repeated episodes of gross hematuria since the age of seven months was admitted to Teaching Hospital, Peradeniya with another episode of gross hematuria. The child was clinically normal and investigations including blood, imaging studies and renal biopsy were unremarkable. Urine checked for bar bodies was positive. A case conference was held and it was decided to keep the child under parental custody under supervision of medico-legal authorities, while the mother is followed up at the psychiatry clinic for depression.

Discussion

Munchausen syndrome (MS) by proxy is a psychiatric disorder which consists of fabricating or inducing illness in a child, usually by his mother, leading to unnecessary and potentially harmful medical investigations and/or treatment which are seen in this case as well. Thus this emphasizes the importance of thinking of MS, before going into potentially harmful investigations when the basic investigations are normal and identifying the importance of having an interlinked e database system in medical facilities in countries like Sri Lanka.