Death Due to Munchausen Syndrome: A Case of Idiopathic Recurrent Right Ventricular Failure and a Review of the Literature

Factitious disorders are rare, identified in less than 1% of patients evaluated by the consultation-liaison psychiatry service in tertiary care centers. These disorders involve falsification of psychologic or physical signs or symptoms; induction of injury or disease associatedwith identified deception; and presentations of oneself as ill, injured, or impaired. Unlike with malingering, there is no obvious external reward. Despite recent attempts at improved classification, factitious disorders continue to be underrecognized and underdiagnosed in general medical patients. Munchausen syndrome accounts for approximately 10% of all factitious illnesses in hospital settings and represents its most persistent and extreme form. This disorder can be associated with high morbidity and medical expenditures but it rarely results in a patient's death. We describe the case of a young woman with Munchausen syndrome who presented to multiple secondary and tertiary care facilities with recurrent right ventricular failure, ascribed to air emboli, who died of her self-injurious behavior. We also review the literature on fatalities associated with factitious illness. 2014. From Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Send correspondence and reprint requests toMuthiahVaduganathan,M.D., M.P.H., Department ofMedicine,MassachusettsGeneralHospital, Harvard Medical School, 55 Fruit St, GRB 740, Boston, MA 02114; e-mail: muthu@md.northwestern.edu & 2014 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved. Case Report