UNUSUAL AND MEMORABLE

Case number 31: Nodular panniculitis as expression of Munchausen’s syndrome (panniculitis artefacta)

A-K Tausche¹, S Hänsel¹, K Tausche¹, S Unger¹, H E Schröder¹, J Pietsch²

¹ Section of Internal Medicine, Department of Rheumatology, University Clinic Carl Gustav Carus, Dresden University of Technology, Fetscherstrasse 74, D- 01307 Dresden, Germany
² Institute of Legal Medicine, University Clinic Carl Gustav Carus, Dresden University of Technology, Fetscherstrasse 74, D- 01307 Dresden, Germany

Correspondence to:
Correspondence to:
Dr A-K Tausche
anne-kathrin.tausche@mailbox.tu-dresden.de

Keywords: panniculitis; Munchausen’s syndrome

The first 150 words of the full text of this article appear below.

A 45 year old woman presented with a 4 year history of fever attacks, generalised fatigue, arthralgias, and recurring painful nodules of the subcutaneous tissue in different localisations. Extensive diagnostic procedures had been carried out in several rheumatological and dermatological departments of university hospitals (13 admissions). Under the diagnosis of nodular panniculitis and because of the deep infiltration, incisions and surgical debridement were often necessary. At the physical examination she had a temperature over 39°C, an approximately plum sized painful nodule in the subcutaneous tissue of the left shoulder, and ulcerations of the left hand and elbow (after surgical debridement) (fig 1).

View larger version (123K): [in this window] [in a new window]   Figure 1  Painful deep nodule—left shoulder.

 

Laboratory tests showed a raised white cell count of 11.6x10⁹/l; an erythrocyte sedimentation rate of 55 mm/1st h, and C reactive protein 215 mg/l. Transaminases were increased, with a -glutamyltransferase of 154 U/l, alanine aminotransferase 53 U/l, and aspartate aminotransferase . . . [Full text of this article]

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