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Separating fact from factitious hemoptysis: a case report
Susan M Mucha1, Linda A Varghese2, Russell E French2
1Susan M. Mucha is a fellow, Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania.Linda A. Varghese is a resident in internal medicine at Allegheny General Hospital.Russell E. French is a fellow, Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital.Daniel A. Shade is an associate professor, Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, and an adjunct professor of medicine, Temple University School of Medicine, Philadelphia, Pennsylvania. tippymadison@gmail.com.
Abstract:
A 61-year-old man with a history of testicular carcinoma and more recently diagnosed metastatic renal cell carcinoma was admitted because of recurrent submassive hemoptysis as evidenced by bright red blood in his bedside basin. Despite an exhaustive workup, including multiple invasive procedures, no cause of the bleeding was found. The diagnosis was Münchausen syndrome manifested as factitious hemoptysis via unusual and modern means. The case is a reminder to all members of the critical care team, from nurses to physicians: When dealing with the frustration of a recurrent problem with no clear answer, remain vigilant and remember the age-old advice to look at the patient… and trust your gut.
