A Rare Case of Factitious Bleeding from Multiple Sites: Munchausen s Syndrome

Case Report

Austin J Psychiatry Behav Sci. 2022; 8(1): 1085.

A Rare Case of Factitious Bleeding from Multiple Sites: Munchausen’s Syndrome

Gomes RR*

Associate Professor, Department of Medicine, Ad-din Women’s Medical College Hospital, Dhaka, Bangladesh

*Corresponding author: Richmond Ronald Gomes, Associate Professor, Department of Medicine, Ad-din Women’s Medical College Hospital, Dhaka, Bangladesh

Received: March 14, 2022; Accepted: April 05, 2022; Published: April 12, 2022


Munchausen’s syndrome is a psychiatric disorder in which patients inflict on themselves an illness or injury for the primary purpose of assuming the sick role. These patients can present with many different complaints and clinical symptoms including self-inflicted bleeding. This report describes a case of lately diagnosed Munchausen’s syndrome who presented with bleeding per nose, mouth, hemolacria, hemoptysis and hematochezia. Physicians should always consider this rare disorder in cases presented with bleeding symptoms of unknown origin. This interesting and rare case is presented to create awareness amongst all specially to medical population about Munchausen syndrome so that they can be diagnosed easily and treated with efficiency as well as misdiagnosis and unnecessary use of medical resources can be avoided. We recommend collateral history taking, exclusion of all possible etiologies and detailed briefing of family members as it plays a vital role to reduce the mental and financial suffering of the patient.

Keywords: Munchausen’s syndrome; Hemolacria; Hematochezia; Hemoptysis


Munchausen’s syndrome is classified as a factitious disorder in the latest version of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) [1]. The term “Munchausen syndrome” was first coined by Richard Asher [2] in 1951 after a German military man, Baron von Munchausen who traveled from place to place telling fantastic tales about his imaginary exploits. He used this term to describe a syndrome in which patients intentionally made symptoms to gain hospital admission repeatedly. The other names of this disorder are hospital addiction, poly-surgical and professional patient syndrome. Patients of munchausen syndrome intentionally produce physical or psychiatric symptoms to gain medical attention and assume a sick role [2]. Munchausen syndrome is a kind of factitious disorder where physical signs and symptoms are predominant and more striking features rather than psychological symptom. Patients with Munchausen syndrome simulate, induce, or aggravate illness to receive medical attention. To achieve this, they may inflict painful, deforming even life-threatening injury on themselves, their children or other dependents. The primary motivation is not avoidance of duties or financial gain rather to receive medical care. Though the exact prevalence of this condition in Bangladesh is not known, limited studies indicate that patients with factitious disorder may comprise approximately 0.8 to 1.0 percent of psychiatry consultation patients [2]. We documented this interesting case of a 18 years female from Dhaka, who was repeatedly reported and admitted in emergency, ENT, EYE, gastroenterology and hematology department with history of bleeding through nose, ears, eyes, anus and mouth and has been a diagnostic dilemma for a long time, till she was successfully diagnosed and treated as a case of munchausen syndrome.

Case Presentation

An 18-year-old unmarried young Bangladeshi female came through the emergency department (ER) with a history of hemoptysis for last twenty-four hours. The patient reported that this was the fourth episode of hemoptysis in one day. She was managed in ER with fluid support and tranexamic acid injections. Her blood pressure was 90/60mm Hg and pulse was 110 per minute. After stabilization, she was transferred to the inpatient ward for further investigation and management. On examination, the patient was in acute distress due to her recurrent bleeding episode. Rest of the physical examination is unremarkable. Her weight was 43kg and height was 152.5cm.

On query, she repeatedly reported in emergency and admitted in ENT, EYE ward with history of bleeding per nose, ears, eyes, mouth and rectum. Earlier she was sent for hematological assessment to ascertain any bleeding or coagulation factor defect. Neither any abnormalities were not found by ENT/EYE specialist nor were any hematological abnormalities detected in laboratory investigations. Her first hospital admission was in 2017 and second time in 2018. On third hospitalization, in 2020 she was sent for psychiatric evaluation. History revealed that the bleeding was intermittent in nature and initially it occurred 10-12 times per day when she was at her residence. But after admission in hospital incidence was decreasing day by day. Lastly it decreased up to 1-2 times per day while staying in hospital.

Inquisitive history digs out that bleeding never started in front of others, when wiped out never bleed further. No abrasions, bruises, lacerations or injury marks were observed in and around bleeding sites and there is no history of per vaginal bleeding. . She had menarche at an age of thirteen years and she had regular menstruation and reported the use of one pad per day for four days every month. Complete work up for bleeding disorders (complete blood count, bleeding time, prothrombin time, activated partial thromboplastin time, serum von Willebrand factor activity with ristocetin cofactor test, quantitative analysis of platelets) and serology (autoimmune disorders) ordered came back normal. Other base line labs were ordered including basic metabolic panel (BMP), liver function test (LFT) chest X-ray (CXR), stool detailed report and urine detailed report was ordered. All her tests came back normal. Upon request of her parents endoscopy of upper GIT and colonoscopy were also performed with normal results. In addition, a viral panel (Hepatitis B and Hepatitis C) and a CT scan of the abdomen and the chest were non-suggestive of any pathology.

The patient was given pantoprazole oral tablets twice a day and was managed symptomatically. Next day she had blood in tears also with sputum as shown in Figure 1 and 2 which was an alarming symptom and raised the concern of hemolacria secondary to ophthalmological disorder. Ophthalmology consult was made and after ruling out every serious possibility like trauma, tumors, etc., she was put under close surveillance for hemolacria episode. There was no mark of any fresh or dried blood on a body orifice and her breast examination was also satisfactory.

Citation: Gomes RR. A Rare Case of Factitious Bleeding from Multiple Sites: Munchausen’s Syndrome. Austin J Psychiatry Behav Sci. 2022; 8(1): 1085.