Síndrome de Munchausen e pseudoparaplegia: relato de caso

Abstract

RESUMO -Apresentamos uma paciente com "paraplegia" de oito anos de evolução, que se internou para retirada de agulhas em região lombar e apresentava história de insuficiência renal, câncer de esôfago, ovários e mama, suspeita de tuberculose pulmonar e várias internações em hospitais clínicos e psiquiátricos. No exame psiquiátrico encontramos indiferença à sua doença, prolixidade e descrição detalhada de seus problemas, falando mal dos atendimentos anteriores. Não encontramos evidências de processos neoplásicos. Tinha movimento em bloco de membros inferiores, com preservação dos reflexos e sensibilidade. A eletromiografia, a tomografia de crânio, a ultra-sonografia abdominal e o RX de tórax foram normais. No RX e na tomografia de coluna lombo-sacra observamos 16 agulhas, semelhantes às de costura, em partes moles. Diagnosticada como síndrome de Munchausen, depois de 15 dias de internação com tratamento antidepressivo, psicoterapia e fisioterapia, melhorou. Três meses depois, a paciente encontrava-se assintomática, não voltando mais ao ambulatório.PALAVRAS CHAVES: síndrome de Munchausen, pseudoparaplegia. Syndrome of Munchausen and pseudoparaplegia: case reportABSTRACT: We present a 36 years old female, with a 8 years history of "paraplegia", who was admitted to our department to have "some needles withdrown" from her back. She refered previous admittances to general and psychiatric hospitals in order to treat several episodes of renal failure, combined with other clinical conditions like pulmonary tuberculosis and esophagus, ovary and breast cancer. On the psychiatric evaluation, we found a patient who seemed to be indifferent to her disease, giving accurate and very elaborated description of her symptoms. She was always complaining about previous medical therapies She moved her both legs simultaneously, without any impairment on reflexes and sensibility. We did not find evidence of tumor processes. The electromyography, cranial CT scan, abdominal ultrasound scan and chest X-ray were normal. Lumbosacral Xray and CT scan showed 16 sewing needles widespread in the lumbosacral soft tissues. A diagnosis of Munchausen syndrome was firmed. After a 15-day trial of anti depressive drug, physiotherapy and psychotherapy, her clinical status significantly improved, reverting its neurological picture after treatment.KEY WORDS: Munchausen syndrome, pseudoparaplegia.Karl Friedrich Hieronymus von Munchausen (1720-1797) serviu nas forças armadas russas na guerra contra os turcos (1672-1763). Após brilhante carreira militar aposentou-se e foi morar perto de Hannover, onde divertia seus amigos e convidados com recordações de suas aventuras na maioria das vezes de forma exagerada, porém não existem evidências que levasse suas histórias à sério. Em 1785, Rudolf Eric Raspe publica o livro "Baron von Munchausen`s narrative of his

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“…Although their precise motivations remain unclear, we assume that it is the genuine care, sympathy, and solicitude of healthcare professionals that is sought, and, therefore, that conditions that elicit the most sympathy may be the most desirable. This would explain the enduring appeal of factitious cancer, 13,30,43,60,74 despite the great difficulty in its simulation.…”

Triparesis: an unusual presentation of factitious disorder

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