Factitious hemoptysis. Adding to the differential diagnosis.

BACKGROUND

We report a dramatic case of factitious hemoptysis in a 36-year-old black man who presented with hemoptysis and chest pain.

METHODS

After an exhaustive evaluation, including many invasive procedures, we discovered that the patient's complaints were fabricated, although the method used to simulate hemoptysis was not determined. Documentation was obtained of at least 23 other hospital admissions with similar complaints. During these hospitalizations, numerous diagnostic procedures were performed, including 16 fiberoptic bronchoscopies and 3 cardiac catheterizations, with negative results.

RESULTS

Review of 11 other reported cases of factitious hemoptysis reveals that these patients are generally young (mean age, 32 years; range, 21 to 47 years) and often health-care workers (4 of 12 cases) and that the method of simulating hemoptysis, if discovered, usually involves a self-inflicted wound (5 cases).

CONCLUSION

A factitious cause should be considered in the differential diagnosis of hemoptysis of unclear etiology, especially when the medical history or the patient's behavior is unusual.