gms | German Medical Science

Objectives: Factitious disorder (Munchausen syndrome) is a life-threatening psychiatric disorder where patients fabricate signs and symptoms of a disease to feign illness. It is an often-overlooked syndrome to be considered in cases of unexplained recurrent and persistent orthopedic infections. Delayed diagnosis can lead to long hospital stays, expensive tests, unnecessary surgical procedures and high morbidity. We analyzed characteristics of patients with suspected factitious disorder at our institution to increase awareness for this lesser-known disorder, which was ultimately diagnosed after excluding other possible sources of infection.

Methods: We report a prospective case series of six patients with suspicion of factitious disorder treated at our institution between 10/2016 to 12/2020. We investigated common clinical and microbiological characteristics, which supported the final diagnosis.

Results and Conclusion: All six patients were females presenting with chronic osteomyelitis, persistent periprosthetic joint infections or recurrent soft tissue infections. Immunodeficiencies were excluded in each case. 4/6 had health care-associated jobs. All had a history of extensive hospital stays throughout different clinics in Germany, where they underwent multiple surgical procedures and received extended courses of antibiotic therapies. The majority had positive polymicrobial blood cultures, even under broad-spectrum antibiotics. Direct observation of wound and catheter manipulation was reported in two cases.

Persistent or recurrent infections in orthopedic patients remain a diagnostic and therapeutic challenge to the multidisciplinary team. In these patients, factitious disorder should be considered, in particular in females with professional medical background and recurrent identification of polymicrobial pathogens belonging to oral or fecal flora.