Raynaud's phenomenon--or just skin with dye?

Munchausen's syndrome is a factitious disorder resulting in unnecessary investigations and operative treatments in a small and well-defined population. Autobiographical falsification is the characteristic of the entity. The case history is presented of a 28-year-old woman admitted to the emergency department with severe pain of acute onset in her fingers and discoloration while washing dishes. She had been diagnosed with Raynaud's phenomenon and had been on antiepileptic drugs. The fingertips of both hands looked cyanotic. Radial and ulnar pulses were intact. She had argued with the personnel obtaining vital signs and had a tendency to hide her right hand, which raised the suspicion that a psychiatric disorder was the primary cause of the visit to the emergency department. A blue piece of dirt on the left shoulder had also augmented these concerns. Munchausen's syndrome was suspected after careful handshaking with hands soaked in alcohol resulted in a blue discoloration on the doctor's palm and fingers. Emergency and primary care physicians should be alert to this type of situation, with a myriad possible scenarios to be differentiated from real conditions.