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Year : 2011  |  Volume : 2  |  Issue : 2  |  Page : 1

Clinical case of Munchausen syndrome in a patient with type 1 diabetes

1 Clinic of Endocrinology, Alexandrovska University Hospital, Medical University - Sofia, Bulgaria
2 Clinic of Psychiatry, Alexandrovska University Hospital, Medical University - Sofia, Bulgaria

Correspondence Address:
Z Kamenov
Head of the Clinic of Endocrinology, Alexandrovska University Hospital, Medical University - Sofia, Bulgaria

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Source of Support: None, Conflict of Interest: None

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Munchausen syndrome is a psychiatric disorder, characterized by intentional self-induction of a disease or injury, feigned or aggravated symptoms meant to attract or increase attention and medical care as that of an ill patient. Certain clinical presentation imposes multiple, costly, occasionally invasive diagnostic procedures, as well as receiving needless conservative or even surgical treatment. By their own actions and exposure to unnecessary medical procedures, the patients with Munchausen syndrome expose themselves to a great risk of serious unintended complications, permanent disability or death. We present a clinical case of a patient with brittle course of type 1 diabetes. Frequent hypoglycemic episodes required multiple hospital admissions. Recurrent hypoglycemias were registered two weeks after discontinuing insulin therapy. The patient was well educated about her disease and denied to have injected herself. No insulin injection device was found despite active search, leading to a variety of supplementary medical investigations. Finally, a hidden insulin pen was found. Although not that rare, the diagnosis of Munchausen Syndrome is a difficult one especially when evaluating "credible" patients with no physical marks that may lead to a suspicion of the syndrome. They require careful consideration by the medical staff in order to find the causes/motivation in these patients, which would respectively give better chances for appropriate actions.

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