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Ann Rheum Dis 63:1195-1196 doi:10.1136/ard.2004.024539
  • Unusual and memorable

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

  1. A-K Tausche1,
  2. S Hänsel1,
  3. K Tausche1,
  4. S Unger1,
  5. H E Schröder1,
  6. J Pietsch2
  1. 1Section of Internal Medicine, Department of Rheumatology, University Clinic Carl Gustav Carus, Dresden University of Technology, Fetscherstrasse 74, D- 01307 Dresden, Germany
  2. 2Institute of Legal Medicine, University Clinic Carl Gustav Carus, Dresden University of Technology, Fetscherstrasse 74, D- 01307 Dresden, Germany
  1. Correspondence to:
    Dr A-K Tausche
    anne-kathrin.tauschemailbox.tu-dresden.de

    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).

    Figure 1

     Painful deep nodule—left shoulder.

    Laboratory tests showed a raised white cell count of 11.6×109 …

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