In a recent study entitled “Fatal non-thrombotic pulmonary embolization in a patient with undiagnosed factitious disorder,” the authors present a case study of a patient with undiagnosed factitious fever that resulted in the patient’s death and highlight the urgent need for early recognition of these disorders so that prevention measures can be introduced before they become fatal. The study was published in the BMC Research Notes journal.
Factitious fever (i.e., a type of fever of unknown origin) is defined when patients exhibit for 3 or more weeks. While its incidence has decreased significantly (as a result of better diagnoses), factitious fever still represents 1 to 10% of fever of unknown origin cases. Factitious fever in patients with chronic medical conditions is particularly challenging to diagnose.
In this new study, the researchers present the case of a 32 year old woman with a medical history of chronic malnutrition and short gut syndrome who required long-term total parenteral nutrition through a peripherally inserted central catheter (PICC). The patient had ongoing chronic pancreatitis (inflammation of the pancreas) and was submitted to a pancreas islet cell transplant. Following the transplant (a period of five months), the 32 year-old woman was hospitalized with abdominal pain and fever of unknown origin. She had multiple infections with atypical pathogens, including α-hemolytic Streptococcus, Achromobacter xylosoxidans, and Mycobacterium mucogenicum and chest computed tomography showed lung infiltrates. The patient died suddenly from cardiac arrest, specifically a right-sided heart failure following acute hypoxemia. Patients’ autopsy confirmed that she suffered from factitious disorder and administrating oral medications through her central catheter.
This case highlights the difficulty in recognizing factitious disorders in patients’ suffering from chronic and serious conditions. The authors note that the fever of unknown origin in this patient was a result of self-administration of oral medications through the center catheter, which led to a fatal lung complication.
The authors alert that cases like the one they present, i.e. recurrent infections with unusual organisms in patients require physicians’ attention for the risk of patients self-injecting and the occurrence of factitious disorders. This is particularly important, as this case suggests, in patients with complex medical conditions. Recognizing that factitious disorders can be fatal is thus necessary so that the multidisciplinary clinical teams can identify the self-harming behaviors of these patients and intervention measures can be implemented in time.
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