Case Presentation of Munchausen Syndrome
by Mazin Ellias, MD,FRCA and Yakub Ellias, MD, FRCS0
In this article, the authors present a rare case of epidural abscess following epidural
analgesia for chronic pain management. While epidural analgesia is most commonly used for
post-operative pain control, recent advances in pain management means an increasing use of
epidural analgesia for both terminal and non-terminal pain syndrome.1 While
mild side effects of epidural analgesia are fairly common, it is rare to encounter serious
infectious complications (meningitis and epidural abscess) or epidural hematoma.1-3
This particular case had unexpected and confounding aspects that ultimately led to a
diagnosis of Munchausen Syndrome. Munchausen Syndrome, also known as “Munchausen
Syndrome by proxy,” is a psychological disorder characterized by stimulated illness,
pathological lying, and wandering from one to another medical service.4-6
Despite being widely reported, little attention have been paid to this syndrome.5
While the probability of encountering a patient who self-harms is small, it does occur and
this is offered as a cautionary report.
Case Presentation
A 43-year old gentleman presented to the pain clinic complaining of right-sided chest wall
pain radiating from the back to the anterior chest wall, almost corresponding to the T6-7
dermatomal area. This pain appeared following thoracotomy for pleurodesis for repeated
pneumothoraces to the right side. Multiple attempts were made to control his reported pain
using antidepressants, anticonvulsants, and a trial of opiate therapy. All attempts failed
to control his pain. His past medical and surgical history was negative for drug abuse,
diabetes, or any immunosuppressive disorder.
He was scheduled for insertion of thoracic epidural catheter with continued infusion of
local anesthetic agent and morphine to attempt to control his pain. An epidural catheter
was inserted between the level of T7 and T8 using the classical approach under aseptic
conditions. The catheter threaded to the level of T5-6. A continuous infusion of morphine
and bupivacaine mixture was used. During the infusion, the patient expressed 50-60% pain
relief.
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— April 2006
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