MUNCHAUSEN-SYNDROME BY PROXY UNMASKED BY NASAL SIGNS

The protean manifestations of child abuse continue to cause diagnostic difficulty. Recent observations of the high mortality in victims of M unchausen syndrome by proxy, and their siblings, reinforce the need fo r early diagnosis and appropriate intervention. We report the nasal ma nifestations which unmasked Munchausen syndrome by proxy in an infant who presented with intestinal and peri-orifical signs masquerading as Crohn's disease. The possibility of Munchausen syndrome by proxy shoul d be considered in an infant with persistent nasal excoriation present ing as part of an undiagnosed illness.