URINARY CALCULI AND MUNCHAUSEN-SYNDROME

Background. - Unlike the so-called Munchausen syndrome by proxy, which is a form of child abuse, Munchausen syndrome is seldom reported in p ediatric literature. Case report. - Anthony, an 8.5-year-old child was referred because he passed several urinary stones. Although biologica l findings and urinary tract ultrasonography were normal, intravenous pyelogram showed a round area of decreased density in front of the ant erior urethra, which disappeared from postmicturation X-ray. For a 1 m onth period, the child passed 20 stones without intense pain. After un dergoing an appendectomy, he was readmitted for left lumbar pain which disappeared after passage of a stone. He spent the following 10 month s without any complaint On later re-admission with similar symptoms Mu nchausen syndrome was suspected because of the discrepancy arising fro m the emission of stones on one hand and the absence of nephritic coli c, of hematuria and of urinary tract dilatation on the other hand. Dia gnosis of Munchausen syndrome was confirmed by chemical analysis which reported that samples were in fact ordinary pebbles and by child's co nfession, during interrogation without his parents, to having introduc ed the pebbles into his urinary tracts. Conclusion. - When unusual cli nical features are present in children, it is necessary to evoke the M unchausen syndrome which can be likened to a distress signal revealing the presence of psychological disorders. (C) 1998, Elsevier, Paris.