Munchausen's syndrome. A case of factitious hemoptysis

Factitious hemoptysis is the bleeding type of Munchausen's syndrome, rarely reported in the literature (only seventeen cases). After a careful and det ailed Literature review the authors report the case of a 22-year-old workin g-woman, with a history of asthma, Mediterranean anaemia and recurrent hemo ptysis, who was admitted several times to the cardiovascular and Respirator y Sciences Department in the Carlo Forlanini Hospital in 1994 for an asthma tic attack and wheeziness at rest, During the admissions the patient underw ent laboratory tests (such as the examination of sputum specimens, urinalys is, tuberculin test, cold agglutinins and pneumotropic virus tests) and dia gnostic studies (fiberoptic bronchoscopy with bronchoalveolar lavage, compu terized tomography and radiography of the chest, bronchial arteriography, b ronchography, perfusion and ventilation lung scan), because she continually presented with hemoptysis, in order to spot and discover the nature of the bleeding, Since such examinations failed (a few of them-namely fiberoptic bronchoscopies - were even performed when she was coughing up blood) and ps ychiatric consultations revealed the presence of psychologically traumatic events in the patient's history which could explain the psychopathic traits of her personality (in bet she was aggressive and unstable in interpersona l relations), a diagnosis of factitious hemoptysis in Munchausen's syndrome was made.