Factitious Disorder Masquerading as a Life-Threatening Anaphylaxis.
Resha KhanalSelin SendilSharad OliBinita BhandariAnas AtrashPublished in: Journal of investigative medicine high impact case reports (2021)
Factitious disorder is a psychiatric disorder in which sufferers intentionally fabricate physical or psychological symptoms in order to assume the role of the patient, without any obvious gain. We present a case of a 23-year-old female with chronic urticaria who presented with dyspnea, dysphasia, mild generalized erythema, abdominal cramps, and headache. She was tachypneic and hypotensive. This was her third admission with similar symptoms within the last 7 months. Tryptase, complement, anti-SM/RNP, Sjogren, Scl-70, C3, and C4 were negative. Computed tomography-guided bone marrow biopsy showed no mast cells. Flow cytometry did not show any immunophenotypic reaction. Other possible differentials including pregnancy, autoimmune disorders, and infections including hepatitis, thyroid disorder, and age-related malignancies were ruled out. After a thorough review, malingering disorder was ruled out, but we noticed the patient's intent of assuming a sick role. Later, the patient was diagnosed with major depressive disorder. Factitious anaphylaxis can present with multiple presentations including a life-threatening condition that mimics true anaphylaxis. A better approach would be thorough clinical evaluation and early multidisciplinary involvement. This case highlights the importance of further evidence-based studies in factitious disorder to decrease the disease burden and reduce the health care cost.
Keyphrases
- major depressive disorder
- computed tomography
- bone marrow
- healthcare
- flow cytometry
- case report
- mental health
- bipolar disorder
- clinical evaluation
- magnetic resonance imaging
- multiple sclerosis
- emergency department
- physical activity
- mesenchymal stem cells
- positron emission tomography
- preterm birth
- sleep quality
- pregnant women
- depressive symptoms
- drug induced
- contrast enhanced
- pet ct