[Munchausen's syndrome: a diagnostic challenge].

The Munchausen's syndrome is a variant of chronic factitious illness with predominantly physical signs and symptoms under the conscious control of the patient without any obvious gain. The disorder has also been called hospital addiction, professional patient syndrome and in the field of dermatology, dermatitis artefacta. Munchausen's syndrome may mimic many different conditions, especially acute abdominal pain, hemorrhagic disorders, rheumatologic manifestations, factitious fever, and injury of skin. We describe a 28-year-old woman, who was admitted at a local teaching hospital and studied during three years with complaints of a bleeding ulcer on the left knee, severe enough to require blood transfusions. Many procedures and tests were performed without pathologic findings. Afterward, she was seen at our institution; during the study, the suspicion had arisen that the patient had manipulated her ulcer, after the diagnosis of factitious disease was communicated, she admitted. Munchausen's syndrome may have a broad spectrum of manifestations; early recognition can avoid unnecessary treatments and invasive diagnostic studies, with their inherent risk of complications.