Key Points
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Suggests clinicians may occasionally be misled by those who present with factitious signs or symptoms.
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Highlights that prompt detection of such cases ensures that patients do not receive unnecessary interventions that may ultimately be harmful.
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Suggests comprehensive history taking and assessment, along with multidisciplinary teamwork, is crucial in identifying these patients and managing them in a sensitive and appropriate manner.
Abstract
Patients with factitious disorder typically present with signs or symptoms suggesting a medical problem, but which transpire to be self-induced or fabricated. Repeated investigations and treatments are often carried out to no avail before this possibility is considered. In this case, a 51-year-old female presented to the oral and maxillofacial surgery unit with toothache and a facial rash. Following admission to hospital a range of investigations were performed, and a tooth was extracted. Judicious attention by nursing staff led to the discovery that the patient had been applying make-up to mimic a skin rash. This concern was raised with the patient and she admitted falsifying the rash. Although this patient may have been experiencing pain, by applying make-up in this manner she sought to exaggerate the severity of her condition and as a result underwent potentially unnecessary procedures. This case provides a reminder that the possibility of factitious disorder should be considered in cases where patients present with symptoms or signs which appear fabricated or self-inflicted, defy anatomical or physiological principles, or do not correlate with the history. Thorough history taking is essential, and access to electronic care records may be informative. Psychiatric follow-up is recommended, but not all patients are willing to engage with this process.
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Rice, S., O'Brien, K., Chew, M. et al. Fabricated facial rash – an unusual presentation of factitious disorder. Br Dent J 225, 1063–1066 (2018). https://doi.org/10.1038/sj.bdj.2018.1036
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DOI: https://doi.org/10.1038/sj.bdj.2018.1036
