Breast surgeons dealing with Munchausen syndrome: A self‐induced necrotic phlegmon of the breast treated with surgery, negative pressure and epidermal fractional skin grafting

What is it about?

The Munchausen's syndrome (MS), is a chronic disorder refractory to therapies, in which patients intentionally make themselves ill repeatedly requesting medical care for the sole purpose of becoming a patient. We report a case of MS in a 35‐year‐old woman admitted for anecrotic phlegmon of the right breast, with hyperaemia and oedema at her breast, with a necrotic breast, fistulas and a smelly secretion. She reported that the cause of the lesion was a blunt trauma and also showed unexplained multiple scars, a skin‐graft on her forearm,fever, increased white‐blood‐cell‐count and wound swabs positive for Escherichia Coli. Despite the age, her medical history was considerable.At 23, she had been subjected twice to a bilateral breast reduction for aesthetic. At 24, she was treated for a loss of substance of the volar aspect of her right forearm. Surgical debridement and subsequent coverage with skin‐graft were required four consecutive times because of recurrences. Two months later, two abdominal wounds appeared, having the same features. Finally, another lesion developed on her left forearm. Hematologic, rheumatologic, infective, allergic and toxic causes were all excluded. Finally, a suspicious amount of toothpaste and after‐shave cream was found during the inspection of the patient's baggage and chemical analysis identified those as the cause of her lesions.

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Why is it important?

The surgeon is the professional to whom these patients most frequently turn. So it's in his responsibility to recognize and direct them to the most appropriate psychiatric treatment.