ESPN 51th Annual Meeting

ESPN 2018


 
HENOCH-SCHOENLEIN PURPURA AND MUNCHAUSEN BY PROXY SYNDROME
ZEYNEP NAGEHAN YÜRÜK YILDIRIM 1 ÖZDE NİSA TÜRKKAN 1 ALEV YILMAZ 1

1- ISTANBUL UNIVERSITY, ISTANBUL FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRIC NEPHROLOGY, ISTANBUL, TURKEY
 
Introduction:

Munchausen syndrome is a psychiatric disorder in which patient itself or the caregiver intentionally fabricate illness. Literally %6 of cases attends to nephrology or urology for seeking medical attention. 

Material and methods:

Herein we present a ten-year-old girl diagnosed as Henoch-Schönlein purpura(HSP) having additional findings consistent with Munchausen syndrome.

Results:

Ten-year-old girl attended to outpatient clinic with palpable purpura on her lower extremities and her thighs. A skin biopsy revealed leucocytoclastic vasculitis with perivascular IgA, C3 and fibrinogen accumulation on immunoflourescence examination. Patient informed and awared about her illness and complications. Two weeks later, patient admitted to our emergency service with abdominal pain and bloody stool. Her physical examination revealed only palpable purpura on her lower extremities. Oral methylprednisolone 2mg/kg/day has been started. Since her symptoms did not resolve during a month, pediatric surgery and gastroenterology consultations have been done. All the blood tests, abdominal CT and Scintigraphy for Meckel diverticulum were normal. Also, macroscopic haematuria and proteinuria appeared in the meantime. Besides her cushingoid appearance, patient’s general condition was fine, her skin findings recovered and her haematocrit levels were normal, even she had persistent bleeding. Red blood cell morphology in the urine sediment was morphic. Patient was kindly asked for urination under surveillance and urine sample was clear. Obtained urine sample put into 2 separate vials and one of them sent to the laboratory via her 21-years-old sister who has accompanied to our patient from the first day of hospital admittance on. The sample sent by the older sister revealed macroscopic haematuria with 3+ blood reaction and urine sediment of 26000 RBC, while the other sample was normal. Further that day the patient recovered and haematuria and haematochezia was resolved.

Conclusions:

 Even there is an illness which might cause hematuria and hematochezia, every physician must have a reasonable doubt for Munchausen by proxy syndrome.