Oppan Kelvin E, Otupri Stephanie
Pediatrics, Ternopil National Medical University, Ternopil, UKR.
Cureus. 2024 May 19;16(5):e60607. doi: 10.7759/cureus.60607. eCollection 2024 May.
Factitious disorder imposed on another (FDIA), formerly known as Munchausen syndrome by proxy (MSBP), constitutes a form of child abuse wherein a caregiver fabricates or induces illness in a person under their care or supervision. Here, we present a case of a two-year-old girl with signs and symptoms suggestive of undifferentiated connective tissue disease (UCTD) and probable autoinflammatory disease, which was a manifestation of FDIA. The patient manifested recurrent febrile episodes and presented with hepatosplenomegaly, elevated inflammatory markers, and mesangial proliferative glomerulonephritis. Regardless of extensive medical interventions, including corticosteroids and immunosuppressive therapy, the patient's condition failed to improve until the caregiver was isolated from the patient. Upon questioning, the caregiver admitted to having administered pyrogenal, an immunomodulator, to induce symptoms. This case highlights the challenges and difficulties of diagnosing and managing FDIA-associated illnesses, drawing attention to the importance of considering this diagnosis in cases of unexplained or recurrent fever in children.
代理型做作性障碍（FDIA），以前称为代理孟乔森综合征（MSBP），是一种虐待儿童的形式，即照顾者在其照顾或监督的人身上编造或诱发疾病。在此，我们报告一例两岁女童，其体征和症状提示未分化结缔组织病（UCTD）和可能的自身炎症性疾病，这是FDIA的一种表现。该患者表现为反复发热，伴有肝脾肿大、炎症标志物升高和系膜增生性肾小球肾炎。尽管进行了广泛的医学干预，包括使用皮质类固醇和免疫抑制治疗，但在照顾者与患者隔离之前，患者的病情一直没有改善。经询问，照顾者承认曾使用免疫调节剂热原质来诱发症状。该病例凸显了诊断和管理与FDIA相关疾病的挑战和困难，提醒人们在儿童不明原因或反复发热的病例中考虑这一诊断的重要性。
