Kwon Younghoon, Koene Ryan J, Cross Caroline, McEntee Jennifer, Green Jaime S
Department of Medicine, University of Minnesota, 420 Delaware Street S.E., Minneapolis, MN, 55455, USA.
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.
BMC Res Notes. 2015 Jul 12;8:302. doi: 10.1186/s13104-015-1265-y.
Factitious fever is extremely challenging to diagnose in patients with complicated chronic medical problems, and represents as much as 10% of fevers of unknown origin. Factitious fever caused by self-injecting oral medications through indwelling central catheters is a diagnostic challenge.
We present a 32-year-old Caucasian female with history of short gut syndrome, malnutrition requiring total parental nutrition, and pancreatic auto-islet transplant with fever of unknown origin. Multiple episodes of bacteremia occurred with atypical pathogens, including α-hemolytic Streptococcus, Achromobacter xylosoxidans, and Mycobacterium mucogenicum. Chest computed tomography was notable for extensive tree-in-bud infiltrates. Sudden cardiac arrest with right-sided heart failure following acute hypoxemia led to her death. Diffuse microcrystalline cellulose emboli with foreign body granulomatosis was found on autopsy. Circumstantial evidence indicated that this patient suffered from factitious disorder, and was self-injecting oral medications through her central catheter.
A high index of suspicion, early recognition, and multifaceted team support is essential to detect and manage patients with factitious disorders before fatal events occur.
在患有复杂慢性疾病的患者中，人为发热极难诊断，在不明原因发热中占比高达10%。通过留置中心静脉导管自行注射口服药物引起的人为发热是一项诊断难题。
我们报告一名32岁的白种女性，有短肠综合征病史，因营养不良需要全胃肠外营养，以及进行了自体胰岛移植，出现不明原因发热。发生了多次由非典型病原体引起的菌血症，包括α溶血性链球菌、木糖氧化无色杆菌和产黏液分枝杆菌。胸部计算机断层扫描显示有广泛的树芽征浸润。急性低氧血症后突然心脏骤停并伴有右侧心力衰竭导致患者死亡。尸检发现弥漫性微晶纤维素栓子伴异物肉芽肿。间接证据表明该患者患有做作性障碍，通过中心静脉导管自行注射口服药物。
高度怀疑、早期识别以及多学科团队支持对于在致命事件发生前检测和管理做作性障碍患者至关重要。
