Factitial illness mimicking rheumatic disease with panniculitis

Factitial disorders can present with a wide spectrum of clinical features and might be overlooked. We identified two patients believed to have factitial disorders mimicking panniculitis at one medical center within 15 months. Both were females in their early forties who had long histories of cutaneous ulcerations, recurrent cellulitis, abscesses, atrophy, and scarring with sparing of inaccessible body areas. They had a) undergone surgical interventions during multiple hospitalizations, b) demonstrated no response to apparently appropriate medical management, c) had thick charts, clinical depression, "hollow" histories, and borderline personalities, and d) exhibited "peregrination" and "laparotomaphilia migrans." Their biopsies suggested amorphous birefringent material of exogenous origin on polarized light microscopy. Factitial disease is an underrecognized clinical syndrome. This diagnosis can be established when it is considered and when thoughtful evaluation is undertaken; this disorder may be amendable to management if patients return for care.