A fatal case of Munchausen syndrome: forensic dermatology aids in establishing the diagnosis.

Munchausen syndrome (factitious disorder imposed on self), a condition in which the patient intentionally injures themselves to create disease signs and symptoms, is difficult to diagnose.  The affected individual not only seeks attention but also sympathy for their illness. A 31-year-old woman with cutaneous Munchausen syndrome who had persistent cutaneous ulcers and new abscesses is described; she died during her hospitalization and postmortem biopsies of her skin lesions and lungs both demonstrated polarizable foreign bodies. Fatal Munchausen syndrome has not commonly been described; including the woman in this report, we are aware of 19 decedents. The cause, mechanism, and manner of death have varied. Like our patient, the manner of death was most frequently undetermined since the circumstances did not permit accident to be differentiated from suicide. In conclusion, forensic dermatology aided in establishing the diagnosis of fatal cutaneous Munchausen syndrome in the woman we report. A biopsy of her non-healing ulcer showed polarizable foreign material that she had inoculated into her skin. Her condition involved not only self-inflicted skin abscesses, but also similar manifestations in her lungs. To prevent unnecessary laboratory tests and procedures and possibly death, healthcare providers need to consider the possibility of Munchausen syndrome.