Dataset Information

Approach to diagnosis of factitious disorder with unexplained hemoptysis: A case report.

ABSTRACT:

Rationale

Hemoptysis or hematemesis is a common clinical symptom in adults, but is unusually to be observed in children. Hemoptysis can occur with circulatory diseases, injuries, several types of systemic diseases, or systemic factors including factitious disorder (FD), which is difficult to be diagnosed. Here, we report a case of hemoptysis caused by FD to provide a diagnostic flow chart for such kind of disease.

Patient concerns

An 11-year-old female patient had a history of hemoptysis or hematemesis for 6 months and suffered with paroxysmal syncope for a month.

Diagnosis and intervention

A series of examinations had been launched to evaluate any possible malformation or abnormalities of the patient including fiberoptic bronchoscopy, cardiac catheterization, gastroscopy, nasolaryngoscopy, electrocardiogram, electroencephalogram, and enhanced magnetic resonance image of the paranasal sinus. Several methods had been performed and tried to stop hemoptysis such as taking hemostatic medications, lavage of fiberoptic bronchoscopy, and embolism for abnormal bronchial arterial using cardiac catheter. All the interventions, however, failed to achieve our treatment goal. Given that more careful observation during hospitalization had been done, and we suspected the symptom of hemoptysis from this patient might be originated from an FD.

Outcomes

Based on the diagnosis of FD, targeted psychological intervention was provided by experts. After the treatment completed, the patient did not present hemoptysis anymore.

Lessons

FD is an uncommon type of disease. This rare case described here is to help us to reconsider the long diagnosis process of hemoptysis with a series of examinations including some invasive procedures, whether all the examinations and interventions are necessary for a nonsevere hemoptysis patient.

SUBMITTER: Yue P

PROVIDER: S-EPMC6380732 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Publications

Approach to diagnosis of factitious disorder with unexplained hemoptysis: A case report.

Yue Peng P Zhou Kaiyu K Hua Yimin Y Fang Jie J Li Yifei Y

Medicine 20190201 6

<h4>Rationale</h4>Hemoptysis or hematemesis is a common clinical symptom in adults, but is unusually to be observed in children. Hemoptysis can occur with circulatory diseases, injuries, several types of systemic diseases, or systemic factors including factitious disorder (FD), which is difficult to be diagnosed. Here, we report a case of hemoptysis caused by FD to provide a diagnostic flow chart for such kind of disease.<h4>Patient concerns</h4>An 11-year-old female patient had a history of hem ...[more]

PMID: 30732130

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Project description:BackgroundDespite cases of factitious disorder imposed on self being documented in the literature for decades, it appears to remain an under-identified and under-diagnosed problem. The present study aimed to explore factitious disorder imposed on self in a series of French patients.MethodsPatients 18 years old and over with factitious disorder imposed on self were retrospectively included by two independent reviewers according to DSM-5 criteria in Rennes University Hospital for the period 1995 to 2019. Patients were identified from a clinical data warehouse.Results49 patients with factitious disorder imposed on self were included. Among them, 36 (73.5%) were female. The average age at diagnosis was 38.4 years. The 16 patients with a health-related profession were all female. Direct evidence of falsification was found in 20.4% of cases. Falsification was mainly diagnosed on the basis of indirect arguments: history of factitious disorder diagnosed in another hospital (12.2%), extensive use of healthcare services (22.4%), investigations that were normal or inconclusive (69.4%), inconsistent or incomplete anamnesis and/or patient refusal to allow access to outside information sources (20.4%), atypical presentation (59.2%), evocative patient behaviour or comments (32.7%), and/or treatment failure (28.6%). Dermatology and neurology were the most frequently involved specialities (24.5%). Nine patients were hospitalized in intensive care. Some of them received invasive treatments, such as intubations, because of problems that were only reported or feigned. The diagnosis of factitious disorder imposed on self was discussed with the patient in 28 cases (57.1%). None of them admitted to making up the disorder intentionally. Two suicide attempts occurred within 3 months after the discussion of the diagnosis. No deaths were recorded. 44.9% of the patients returned to the same hospital at least once in relation to factitious disorder imposed on self.ConclusionsThe present study reinforces data in favour of a predominance of females among patients with factitious disorder imposed on self. This diagnosis is difficult and is based on a range of arguments. While induced cases can be of low severity, cases that are only feigned can lead to extreme medical interventions, such as intubation.

Project description:BackgroundParvimonas micra (P. micra), a Gram-positive anaerobic bacterium, exhibits colonization tendencies on oral mucosal and skin surfaces, potentially evolving into a pathogenic entity associated with diverse diseases. The diagnostic trajectory for P. micra-related diseases encounters delays, often with severe consequences, including fatality, attributed to the absence of symptom specificity and challenges in culture. The absence of a consensus on the diagnostic and therapeutic approaches to P. micra exacerbates the complexity of addressing associated conditions. This study aims to elucidate and scrutinize the clinical manifestations linked to P. micra, drawing insights from an extensive literature review of pertinent case reports.Case presentationA 53-year-old male sought medical attention at our institution presenting with recurrent hemoptysis. Empirical treatment was initiated while awaiting pathogen culture results; however, the patient's symptoms persisted. Subsequent metagenomic next-generation sequencing (mNGS) analysis revealed a pulmonary infection attributable to P. micra. Resolution of symptoms occurred following treatment with piperacillin sulbactam sodium and moxifloxacin hydrochloride. A comprehensive literature review, utilizing the PubMed database, was conducted to assess case reports over the last decade where P. micra was identified as the causative agent.ConclusionThe literature analysis underscores the predilection of P. micra for immunocompromised populations afflicted by cardiovascular diseases, diabetes, orthopedic conditions, and tumors. Risk factors, including oral and periodontal hygiene, smoking, and alcohol consumption, were found to be associated with P. micra infections. Clinical manifestations encompassed fever, cough, sputum production, and back pain, potentially leading to severe outcomes such as Spondylodiscitis, septic arthritis, lung abscess, bacteremia, sepsis, and mortality. While conventional bacterial culture remains the primary diagnostic tool, emerging technologies like mNGS offer alternative considerations. In terms of treatment modalities, β-lactam antibiotics and nitroimidazoles predominated, exhibiting recovery rates of 56.10% (46/82) and 23.17% (19/82), respectively. This case report and literature review collectively aim to enhance awareness among clinicians and laboratory medicine professionals regarding the intricacies of P. micra-associated infections.

Dataset Information

Approach to diagnosis of factitious disorder with unexplained hemoptysis: A case report.

Rationale

Patient concerns

Diagnosis and intervention

Outcomes

Lessons

Publications

Approach to diagnosis of factitious disorder with unexplained hemoptysis: A case report.

Similar Datasets

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