Medically unexplained myopathy due to ipecac abuse

The use of ipecac, once recommended as an emetic for use in toxic ingestions, has more recently been discouraged for use in home and emergency room settings. It remains readily available, and has been associated with abuse in eating disorders and Munchausen syndrome by proxy. This case discusses an adolescent boy who surreptitiously abused ipecac in the context of distress over parental conflict, and the extensive medical workup undertaken to evaluate unexplained symptoms of proximal muscle weakness, abdominal pain, and, eventually, cardiomyopathy that are sequelae of ipecac toxicity. Clinicians should be alerted to ipecac ingestion with similar presentation.