Laboratory diagnosis of factitious disorder: A systematic review of tools useful in the diagnosis of Munchausen's syndrome

New Zealand Medical Journal

Volumn 124, Issue 1342, 2011, Pages 66-81

  Kenedi, Christopher A ^a,b,c   Shirey, Kristen G ^b   Hoffa, Mary ^b   Zanga, Joseph ^b   Lee, Jonathan C ^d   Harrison, Jeremy D ^b   Preud'Homme, Xavier A ^b  

^a AUCKLAND CITY HOSPITAL   (New Zealand)

^b DUKE UNIVERSITY MEDICAL CENTER   (United States)

^c UNIVERSITY OF AUCKLAND   (New Zealand)

^d Farley Center   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTICOAGULANT AGENT; ATENOLOL; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM CHANNEL BLOCKING AGENT; CHORIONIC GONADOTROPIN; DIGITALIS; METOPROLOL; NONSTEROID ANTIINFLAMMATORY AGENT; SALICYLIC ACID; VITAMIN K GROUP; WARFARIN;

ANALYTIC METHOD; ANTICOAGULATION; BIOPSY; BLOOD SAMPLING; CARDIOVASCULAR DISEASE; CLINICAL LABORATORY; CLINICAL PRACTICE; COMPUTER ASSISTED TOMOGRAPHY; DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS; DIAGNOSTIC IMAGING; DIAGNOSTIC TEST; DIFFERENTIAL DIAGNOSIS; DRUG ABUSE; DRUG BLOOD LEVEL; DRUG DETERMINATION; EAR NOSE THROAT DISEASE; ELECTRODIAGNOSIS; ENDOCRINE DISEASE; ENDOSCOPY; EYE DISEASE; FACTITIOUS DISEASE; GASTROINTESTINAL DISEASE; GASTROINTESTINAL ENDOSCOPY; GASTROINTESTINAL HEMORRHAGE; GYNECOLOGIC DISEASE; HEART ARRHYTHMIA; HEMATOLOGIC DISEASE; HIGH PERFORMANCE LIQUID CHROMATOGRAPHY; HISTOLOGY; HORMONE DETERMINATION; HUMAN; HYPERTENSION; INFECTION; LABORATORY DIAGNOSIS; LABORATORY TEST; LUPUS ERYTHEMATOSUS; MEDICAL TECHNOLOGY; MICROSCOPY; MUNCHAUSEN SYNDROME; NEOPLASM; NEUROIMAGING; NEUROLOGIC DISEASE; NUCLEAR MAGNETIC RESONANCE IMAGING; PSYCHIATRIC DIAGNOSIS; RADIODIAGNOSIS; RESPIRATORY TRACT DISEASE; REVIEW; RHEUMATOID ARTHRITIS; SKIN DISEASE; SYMPTOM; SYSTEMATIC REVIEW; URINALYSIS; UROGENITAL TRACT DISEASE; VASCULITIS;

CLINICAL LABORATORY TECHNIQUES; DIAGNOSIS, DIFFERENTIAL; HUMANS; MUNCHAUSEN SYNDROME;

EID: 80052725296     PISSN: None     EISSN: 11758716     Source Type: Journal    
DOI: None     Document Type: Review

References (130)

1. Asher R. Munchausen's syndrome. Lancet. 1951 1951;1:339-341.
2. Wallach J. Laboratory diagnosis of factitious disorders. Arch Intern Med. Aug 8 1994;154(15):1690-1696.
3. Fliege H, Grimm A, Eckhardt-Henn A, Gieler U, Martin K, Klapp BF. Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics. Jan-Feb 2007;48(1):60-64.
4. Sutherland AJ, Rodin GM. Factitious disorders in a general hospital setting: clinical features and a review of the literature. Psychosomatics. Fall 1990;31(4):392-399.
5. Kapfhammer HP, Rothenhausler HB, Dietrich E, Dobmeier P, Mayer C. [Artifactual disorders--between deception and self-mutilation. Experiences in consultation psychiatry at a university clinic]. Nervenarzt. May 1998;69(5):401-409.
6. Fink P. The use of hospitalizations by persistent somatizing patients. Psychol Med. Feb 1992;22(1):173-180.
7. Aduan RP, Fauci AS, Dale DC, Herzberg JH, Wolff SM. Factitious fever and self-induced infection: a report of 32 cases and review of the literature. Ann Intern Med. Feb 1979;90(2):230-242.
8. Knockaert DC, Vanneste LJ, Vanneste SB, Bobbaers HJ. Fever of unknown origin in the 1980s. An update of the diagnostic spectrum. Arch Intern Med. Jan 1992;152(1):51-55.
9. Caocci G, Pisu S, La Nasa G. A simulated case of chronic myeloid leukemia: the growing risk of Munchausen's syndrome by internet. Leuk Lymphoma. Sep 2008;49(9):1826-1828.
10. Feldman MD. Munchausen by Internet: detecting factitious illness and crisis on the Internet. South Med J. Jul 2000;93(7):669-672.
11. Stephenson J. Patient pretenders weave tangled "Web" of deceit. JAMA. Oct 21 1998;280(15):1297.
12. Gordon LA. Watch out. Munchausen patients have found the computer. Med Econ. Sep 8 1997;74(18):118, 121, 125-117.
13. de Fontaine S, Van Geertruyden J, Preud'homme X, Goldschmidt D. Munchausen syndrome. Ann Plast Surg. Feb 2001;46(2):153-158.
14. Shah KA, Forman MD, Friedman HS. Munchausen's syndrome and cardiac catheterization. A case of a pernicious interaction. JAMA. Dec 10 1982;248(22):3008-3009.
15. Krahn LE LJ, Richardson JW, Martin MJ, O'Connor MK. Hypokalemia leading to Torsades de Pointes: Munchausen's disorder or bulimia nervosa?. Gen Hosp Psychiatry Sept 19 1997(5):7.
16. Bergethon PR. Factitious ventricular tachycardia. Ann Intern Med. Oct 1987;107(4):593-594.
17. Mitchell CC, Frank MJ. Pseudobradycardia during Holter monitoring. The electronic Munchausen syndrome? JAMA. Jul 23 1982;248(4):469-470.
18. Burchell HB. Digitalis poisoning: historical and forensic aspects. J Am Coll Cardiol. Feb 1983;1(2 Pt 1):506-516.
19. Chambers E, Yager J, Apfeldorf W, Camps-Romero E. Factitious aortic dissection leading to thoracotomy in a 20-year-old man. Psychosomatics. Jul-Aug 2007;48(4):355-358.
20. Hopkins RA, Harrington CJ, Poppas A. Munchhausen Syndrome simulating acute aortic dissection. Ann Thorac Surg. Apr 2006;81(4):1497-1499.
21. Steinwender C, Hofmann R, Kypta A, Leisch F. Recurrent symptomatic bradycardia due to secret ingestion of beta-blockers--a rare manifestation of cardiac Munchhausen syndrome. Wien Klin Wochenschr. Sep 2005;117(18):647-650.
22. Huang J, Sun J, Zhou X, You T. Determination of atenolol and metoprolol by capillary electrophoresis with tris(2,2'-bipyridyl)ruthenium(ii) electrochemiluminescence detection. Anal Sci. Feb 2007;23(2):183-188.
23. Flaherty ML, Infante M, Tinsley JA, Black JL, 3rd. Factitious hypertension by pseudoephedrine. Psychosomatics. Mar-Apr 2001;42(2):150-152.
24. Fang H, Zeng Z, Liu L. Centrifuge microextraction coupled with on-line back-extraction fieldamplified sample injection method for the determination of trace ephedrine derivatives in the urine and serum. Anal Chem. Sep 1 2006;78(17):6043-6049.
25. Kailasam MT, Parmer RJ, Stone RA, et al. Factitious pheochromocytoma: novel mimickry by Valsalva maneuver and clues to diagnosis. Am J Hypertens. Jun 1995;8(6):651-655.
26. Rude BL, Townsend RR, DiPette DJ. Case report: stimulation of severe hypertension as a means of malingering. Am J Med Sci. Oct 1992;304(4):258-260.
27. Kwon EJ, Dans M, Koblenzer CS, Elenitsas R, James WD. Dermatitis artefacta. J Cutan Med Surg. Mar-Apr 2006;10(2):108-113.
28. Mahirogullari M, Chloros GD, Cilli F, Cakmak S, Semiz UB, Kiral A. Factitious subcutaneous emphysema of an extremity. Joint Bone Spine. Jan 2008;75(1):84-86.
29. Zonuz AT, Treister N, Mehdipour F, Farahani RM, Tubbs RS, Shoja MM. Factitial pemphigus-like lesions. Med Oral Patol Oral Cir Bucal. May 2007;12(3):E205-208.
30. Rogers M, Fairley M, Santhanam R. Artefactual skin disease in children and adolescents. Australas J Dermatol. Nov 2001;42(4):264-270.
31. Levitz SM, Tan OT. Factitious dermatosis masquerading as recurrent herpes zoster. Am J Med. Apr 1988;84(4):781-783.
32. Lesher JL, Jr., Peterson CM, Lane JE. An unusual case of factitious onychodystrophy. Pediatr Dermatol. May-Jun 2004;21(3):239-241.
33. Lepping P, Freudenmann RW. Delusional parasitosis: a new pathway for diagnosis and treatment. Clin Exp Dermatol. Mar 2008;33(2):113-117.
34. Cizza G, Nieman LK, Doppman JL, et al. Factitious Cushing syndrome. J Clin Endocrinol Metab. Oct 1996;81(10):3573-3577.
35. Lin CL, Wu TJ, Machacek DA, Jiang NS, Kao PC. Urinary free cortisol and cortisone determined by high performance liquid chromatography in the diagnosis of Cushing's syndrome. J Clin Endocrinol Metab. Jan 1997;82(1):151-155.
36. Mantero F, Armanini D, Opocher G, et al. Mineralocorticoid hypertension due to a nasal spray containing 9 alpha-fluoroprednisolone. Am J Med. Sep 1981;71(3):352-357.
37. Ross DS. Syndromes of thyrotoxicosis with low radioactive iodine uptake. Endocrinol Metab Clin North Am. Mar 1998;27(1):169-185.
38. Yoon SJ, Kim DM, Kim JU, et al. A case of thyroid storm due to thyrotoxicosis factitia. Yonsei Med J. Apr 30 2003;44(2):351-354.
39. Gama R, Teale JD, Marks V. Best practice No 173: clinical and laboratory investigation of adult spontaneous hypoglycaemia. J Clin Pathol. Sep 2003;56(9):641-646.
40. Earle KE, Rushakoff RJ, Goldfine ID. Inadvertent sulfonylurea overdosage and hypoglycemia in an elderly woman: failure of serum hypoglycemia screening. Diabetes Technol Ther. 2003;5(3):449-451.
41. Horwitz DL. Factitious and artifactual hypoglycemia. Endocrinol Metab Clin North Am. Mar 1989;18(1):203-210.
42. Baddley JW, Daberkow D, Hilton CW. Insulinoma masquerading as factitious hypoglycemia. South Med J. Nov 1998;91(11):1067-1069.
43. Hoizey G, Lamiable D, Trenque T, et al. Identification and quantification of 8 sulfonylureas with clinical toxicology interest by liquid chromatography-ion-trap tandem mass spectrometry and library searching. Clin Chem. Sep 2005;51(9):1666-1672.
44. Hsiao RJ, Parmer RJ, Takiyyuddin MA, O'Connor DT. Chromogranin A storage and secretion: sensitivity and specificity for the diagnosis of pheochromocytoma. Medicine (Baltimore). Jan 1991;70(1):33-45.
45. Van Der Horst-Schrivers AN JP, Boezen HM, Schouten JP, Kema IP & Links TP. odine-123 metaiodobenzylguanidine scintigraphy in localising phaeochromocytomas--experience and meta-analysis. Anticancer Res. 2006;26:1599-1604.
46. Stern TA, Cremens CM. Factitious pheochromocytoma. One patient history and literature review. Psychosomatics. May-Jun 1998;39(3):283-287.
47. Portioli I, Valcavi R. Factitious phaeochromocytoma: a case for Sherlock Holmes. Br Med J (Clin Res Ed). Dec 19-26 1981;283(6307):1660-1661.
48. Keiser HR. Surreptitious self-administration of epinephrine resulting in 'pheochromocytoma'. JAMA. Sep 18 1991;266(11):1553-1555.
49. Topazian M, Binder HJ. Brief report: factitious diarrhea detected by measurement of stool osmolality. N Engl J Med. May 19 1994;330(20):1418-1419.
50. Bowie EJ, Todd M, Thompson JH, Jr., Owen CA, Jr., Wright IS. Anticoagulant malingerers (the "dicumarol-eaters"). Am J Med. Nov 1965;39(5):855-864.
51. Fine KD, Santa Ana CA, Fordtran JS. Diagnosis of magnesium-induced diarrhea. N Engl J Med. Apr 11 1991;324(15):1012-1017.
52. Shelton JH, Santa Ana CA, Thompson DR, Emmett M, Fordtran JS. Factitious diarrhea induced by stimulant laxatives: accuracy of diagnosis by a clinical reference laboratory using thin layer chromatography. Clin Chem. Jan 2007;53(1):85-90.
53. Rose MI, Dicker MA, Gouge TH. Factitious gastrointestinal bleeding: a case of autophlebotomy and ingestion. Am J Gastroenterol. Jul 1996;91(7):1457-1459.
54. McIntyre AS, Kamm MA. A case of factitious colonic bleeding. J R Soc Med. Jul 1990;83(7):465-466.
55. Hogenauer C, Eherer A, Pfeifer J, Langner C. Chronic longitudinal NSAID-related ulcer of the colon ("colon single-stripe sign") in Munchhausen syndrome. Endoscopy. Sep 2008;40 Suppl 2:E233.
56. Klein O, Maunoury V, Cortot A, et al. Occult aspirin intake revealed by a bleeding colonic angiodysplasia. Am J Gastroenterol. Jul 1991;86(7):929-930.
57. Bakkers JT, Crobach LF, Pauwels EK. Factitious gastrointestinal bleeding. J Nucl Med. Jun 1985;26(6):666-667.
58. Yamashita M, Azuma J. Urinary excretion of ipecac alkaloids in human volunteers. Vet Hum Toxicol. Oct 2002;44(5):257-259.
59. Sutphen JL, Saulsbury FT. Intentional ipecac poisoning: Munchausen syndrome by proxy. Pediatrics. Sep 1988;82(3 Pt 2):453-456.
60. Bader AA, Kerzner B. Ipecac toxicity in "Munchausen syndrome by proxy". Ther Drug Monit. Apr 1999;21(2):259-260.
61. Rashid N. Medically unexplained myopathy due to ipecac abuse. Psychosomatics. Mar-Apr 2006;47(2):167-169.
62. Johnson JE, Carpenter BL, Benton J, Cross R, Eaton LA, Jr., Rhoads JM. Hemorrhagic colitis and pseudomelanosis coli in ipecac ingestion by proxy. J Pediatr Gastroenterol Nutr. May 1991;12(4):501-506.
63. Johansen SS, Jensen JL. Liquid chromatography-tandem mass spectrometry determination of loperamide and its main metabolite desmethylloperamide in biological specimens and application to forensic cases. J Chromatogr B Analyt Technol Biomed Life Sci. Nov 5 2004;811(1):31-36.
64. Schwartz JG, Xenakis EM. Munchausen's syndrome and the laboratory. Self-injection of human chorionic gonadotropin. Arch Pathol Lab Med. Jan 1995;119(1):85-88.
65. Berry RG, Morrison JA, Watts JW, Anagnost JW, Gonzalez JJ. Surreptitious superwarfarin ingestion with brodifacoum. South Med J. Jan 2000;93(1):74-75.
66. Chua JD, Friedenberg WR. Superwarfarin poisoning. Arch Intern Med. Sep 28 1998;158(17):1929-1932.
67. O'Reilly RA AP. Covert anticoagulant ingestion: study of 25 patients and review of world literature. 1976;55(5):389-399.
68. Schmaier AH, Carabello JA, Day HJ, Barry WE. Factitious heparin administration. Ann Intern Med. Nov 1981;95(5):592-593.
69. Bright R, Eisendrath S, Damon L. A case of factitious aplastic anemia. Int J Psychiatry Med. 2001;31(4):433-441.
70. Ford CV, Stein R, Kelly MP, Adelson LM. Factitial aplastic anemia. J Nerv Ment Dis. Jun 1984;172(6):369-372.
71. Ballas SK. Factitious sickle cell acute painful episodes: a secondary type of Munchausen syndrome. Am J Hematol. Dec 1996;53(4):254-258.
72. Ballas SK. Munchausen sickle cell painful crisis. Ann Clin Lab Sci. Jul-Aug 1992;22(4):226-228.
73. Reid DM, Shulman NR. Drug purpura due to surreptitious quinidine intake. Ann Intern Med. Feb 1988;108(2):206-208.
74. Abraham R, Whitehead S. Factitious quinine-induced thrombocytopenia. Med J Aust. Jan 5 1998;168(1):19-20.
75. Catalano G, Toner LC, Alberts VA, Catalano MC. Factitious disorder presenting as bacteremia. Case report and literature review. J Fla Med Assoc. Aug 1995;82(8):535-539.
76. Blyth CC, Russell S, Zwi KJ, Taitz J, Fairley M, Post JJ. Munchausen syndrome by proxy and recurrent polymicrobial bacteremia. Pediatr Infect Dis J. Feb 2007;26(2):191.
77. Frumkin LR, Victoroff JI. Chronic factitious disorder with symptoms of AIDS. Am J Med. Jun 1990;88(6):694-696.
78. Stough DB, Roberson GB, White C. A spitting image. Cutis. Feb 1989;43(2):135-136.
79. Anderson JC, Ewan PW, Compston ND. Haemorrhage and fever in the Munchausen syndrome. Postgrad Med J. Jul 1972;48(561):445-447.
80. Thompson PD, Colebatch JG, Brown P, et al. Voluntary stimulus-sensitive jerks and jumps mimicking myoclonus or pathological startle syndromes. Mov Disord. 1992;7(3):257-262.
81. Trimble MR. Serum prolactin in epilepsy and hysteria. Br Med J. 1987;2:1682-1684.
82. Bye AM, Nunan J. Video EEG analysis of non-ictal events in children. Clin Exp Neurol. 1992;29:92-98.
83. French J. Pseudoseizures in the era of video-electroencephalogram monitoring. Curr Opin Neurol. Apr 1995;8(2):117-120.
84. Bodde NM, Brooks JL, Baker GA, Boon PA, Hendriksen JG, Aldenkamp AP. Psychogenic non-epileptic seizures--diagnostic issues: a critical review. Clin Neurol Neurosurg. Jan 2009;111(1):1-9.
85. D'Avanzo M, Santinelli R, Tolone C, Bettinelli A, Bianchetti MG. Concealed administration of frusemide simulating Bartter syndrome in a 4.5-year-old boy. Pediatr Nephrol. Dec 1995;9(6):749-750.
86. Tran HA. A woman with malaise and hyponatremia. Hyponatremia factitia (Munchausen syndrome) secondary to desmopressin use. Arch Pathol Lab Med. Feb 2006;130(2):e15-18.
87. Sekine K, Kojima I, Fujita T, Uchino K, Isozaki S, Ogata E. Factitious Bartter's syndrome induced by surreptitious intake of furosemide. Endocrinol Jpn. Oct 1982;29(5):653-657.
88. Duffy TP. The Red Baron. N Engl J Med. Aug 6 1992;327(6):408-411.
89. Ifudu O, Kolasinski SL, Friedman EA. Brief report: kidney-related Munchausen's syndrome. N Engl J Med. Aug 6 1992;327(6):388-389.
90. Flynn J. Munchausen syndrome. N Y State J Med. 1992;92:301-305.
91. Abrol RP, Heck A, Gleckel L, Rosner F. Self-induced hematuria. J Natl Med Assoc. Feb 1990;82(2):127-128.
92. Baker MD, Baldassano RN. Povidone iodine as a cause of factitious hematuria and abnormal urine coloration in the pediatric emergency department. Pediatr Emerg Care. Dec 1989;5(4):240-241.
93. Fukuhara S, Kawamura N, Kakuta Y, Imazu T, Hara T, Yamaguchi S. [Case of self mutilation of urethra in a Munchausen's syndrome patient]. Hinyokika Kiyo. Nov 2007;53(11):829-831.
94. Schmidt F, Strutz F, Quellhorst E, Muller GA. Nephrectomy and solitary kidney biopsy in a patient with Munchausen's syndrome. Nephrol Dial Transplant. May 1996;11(5):890-892.
95. Reich JD, Hanno PM. Factitious renal colic. Urology. Dec 1997;50(6):858-862.
96. Gault MH, Campbell NR, Aksu AE. Spurious stones. Nephron. 1988;48(4):274-279.
97. Attar K, Lee G, Rowe E, Hudd C. The secret of the phantom stone: a case report. Int Urol Nephrol. 2004;36(1):27-28.
98. Tojo A, Nanba S, Kimura K, et al. Factitious proteinuria in a young girl. Clin Nephrol. Jun 1990;33(6):299-302.
99. Mitas JA, 2nd. Exogenous protein as the cause of nephrotic-range proteinuria. Am J Med. Jul 1985;79(1):115-118.
100. Levenson JL, Chafe W, Flanagan P. Factitious ovarian cancer: feigning via resources on the internet. Psychosomatics. Jan-Feb 2007;48(1):71-73.
101. Feldman MD, Peychers ME. Legal issues surrounding the exposure of "Munchausen by Internet". Psychosomatics. Sep-Oct 2007;48(5):451-452.
102. Feldman MD. Prophylactic bilateral radical mastectomy resulting from factitious disorder. Psychosomatics. Nov-Dec 2001;42(6):519-521.
103. Feldman MD, Hamilton JC. Mastectomy resulting from factitious disorder. Psychosomatics. Jul-Aug 2007;48(4):361.
104. Grenga TE, Dowden RV. Munchausen's syndrome and prophylactic mastectomy. Plast Reconstr Surg. Jul 1987;80(1):119-120.
105. Rosenberg MW, Hughes LE. Artefactual breast disease: a report of three cases. Br J Surg. Jul 1985;72(7):539-541.
106. Warrens AN, Ron MA, Dawling S. Positive diagnosis of self-medication with homatropine eye drops. Br J Psychiatry. Jan 1990;156:124-125.
107. Rosenberg PN, Krohel GB, Webb RM, Hepler RS. Ocular Munchausen's syndrome. Ophthalmology. Aug 1986;93(8):1120-1123.
108. Lembach RG, Ringel DM. Factitious bilateral crystalline keratopathy. Cornea. Jul 1990;9(3):246-248.
109. Minemura K, Nagahara M, Kaburaki T, et al. [Case of recurrent fungal endophthalmitis with suspected Munchausen syndrome]. Nippon Ganka Gakkai Zasshi. Mar 2006;110(3):188-192.
110. Mushtaq B, Kumar V, Saeed T, Bacon PA, Murray PI. Self-inflicted anterior scleritis. Eye. Jan 2003;17(1):107-108.
111. Zamir E, Read RW, Rao NA. Self-inflicted anterior scleritis. Ophthalmology. Jan 2001;108(1):192-195.
112. Pokroy R, Marcovich A. Self-inflicted (factitious) conjunctivitis. Ophthalmology. Apr 2003;110(4):790-795.
113. Baskin DE, Stein F, Coats DK, Paysse EA. Recurrent conjunctivitis as a presentation of munchausen syndrome by proxy. Ophthalmology. Aug 2003;110(8):1582-1584.
114. Kapoor HK, Jaison SG, Chopra R, Kakkar N. Factitious keratoconjunctivitis. Indian J Ophthalmol. Dec 2006;54(4):282-283.
115. Vaiman M, Shoval G, Gavriel H. The electrodiagnostic examination of psychogenic swallowing disorders. Eur Arch Otorhinolaryngol. Jun 2008;265(6):663-668.
116. Egan AJ, Tazelaar HD, Myers JL, Abell-Aleff PC. Munchausen syndrome presenting as pulmonary talcosis. Arch Pathol Lab Med. Aug 1999;123(8):736-738.
117. Hendrix S, Sale S, Zeiss CR, Utley J, Patterson R. Factitious Hymenoptera allergic emergency: a report of a new variant of Munchausen's syndrome. J Allergy Clin Immunol. Jan 1981;67(1):8-13.
118. Patterson R, Schatz M. Factitious allergic emergencies: anaphylaxis and laryngeal "edema". J Allergy Clin Immunol. Aug 1975;56(2):152-159.
119. Croft PR, Racz MI, Bloch JD, Palmer CH. Autopsy confirmation of severe pulmonary interstitial fibrosis secondary to Munchausen syndrome presenting as cystic fibrosis. J Forensic Sci. Sep 2005;50(5):1194-1198.
120. Leonard A, Leal T, Godding V, Villanueva P, Wallemacq P, Lebecque P. Sweat potassium concentration may help to identify falsification of sweat test: a case report. Clin Biochem. Sep 2008;41(13):1110-1112.
121. Rusakow LS, Gershan WM. Hemoptysis and Munchausen syndrome. Chest. Oct 1994;106(4):1308-1309.
122. Kokturk N, Ekim N, Aslan S, Kanbay A, Acar AT. A rare cause of hemoptysis: factitious disorder. South Med J. Feb 2006;99(2):186-187.
123. Baktari JB, Tashkin DP, Small GW. Factitious hemoptysis. Adding to the differential diagnosis. Chest. Mar 1994;105(3):943-945.
124. Burkle FM, Jr., Calabro JJ, Parks FB. Munchausen's syndrome presenting as respiratory failure requiring intubation. Ann Emerg Med. Feb 1987;16(2):203-208.
125. Cole RP, Walter KL. Factitious intrinsic PEEP in a patient with respiratory failure. Respiration. 2001;68(5):555.
126. Klaassen FA, Schober P, Schwarte LA, Boer C, Loer SA. Acute respiratory failure leading to emergency intubation: an unusual manifestation of Munchausen's syndrome. Resuscitation. Dec 2007;75(3):534-539.
127. Samaniah N, Horowitz J, Buskila D, Sukenik S. An unusual case of factitious arthritis. J Rheumatol. Sep 1991;18(9):1424-1426.
128. Apfelbaum JD, Williams HJ. Factitious simulation of systemic lupus erythematosus. West J Med. Mar 1994;160(3):259-261.
129. Fonseca E, Rubio G. Factitious systemic lupus erythematosus. Lupus. Jun 1993;2(3):195-197.
130. Archer-Dubon C, Orozco-Topete R, Reyes-Gutierrez E. Two cases of psychogenic purpura. Rev Invest Clin. Mar-Apr 1998;50(2):145-148.