PERSISTENT CEREBROSPINAL-FLUID OTORRHEA - A CASE OF MUNCHAUSENS-SYNDROME BY PROXY

A case is presented of a young child who initially presented with recu rrent bacterial meningitis 1 year after significant head trauma and wa s found to have cerebrospinal fluid (CSF) leakage into the middle ear. Surgical procedures were devised to attempt to stop this abnormal flo w, but inexplicably clear otorrhea biochemically identical to CSF pers isted for weeks. The child's mother was apparently soaking the surgica l dressings with CSF obtained through a lumbar drain and confessed to this activity after she was found to have tampered with an intravenous catheter. This activity resulted in a prolonged hospital stay and sev eral presumably unnecessary procedures. Munchausen's syndrome, typifie d by intentional mimicry of symptoms of serious illness backed by plau sible medical history, is well-described. Rarer is the syndrome by pro xy, where parents and/or caregivers, by falsifying histories, fabricat ing laboratory evidence, or deliberately generating bodily lesions, ca use unneeded diagnostic and therapeutic procedures to be performed on their young victims. This form of child abuse is hidden by the perpetr ator's apparent concern and involvement in the care of the victim. The literature is reviewed, this form of abuse is discussed, and the role of communication of suspicion between the various health care workers is stressed. The medical and social settings in which this disorder i s prevalent are covered. Early detection of this entity is essential i n rescuing the victim from life-threatening abuse and in obtaining app ropriate therapy for the abuser. (C) 1997 Elsevier Science Ireland Ltd .