Unexplained destructive nasal lesions in half-brothers: A possible case of Munchausen syndrome by proxy

Area of Science:

• Medical Specialties
• Pediatrics
• Psychiatry

Background:

• Munchausen syndrome by proxy (MSBP) involves a caregiver fabricating or inflicting illness on another for personal gain.
• While otolaryngology cases often involve facial or ear injuries, nasal involvement is infrequently reported.
• Chronic destructive nasal lesions present a diagnostic challenge with a wide differential, potentially leading to prolonged healthcare utilization.

Observation:

• This case report details MSBP in two half-brothers presenting with unexplainable nasal destruction.
• The presentation mimicked other destructive nasal conditions, necessitating extensive specialist consultations.
• The caregiver's actions were central to the repeated and severe nasal injuries.

Findings:

• MSBP should be considered in the differential diagnosis of unexplained chronic nasal destruction, particularly in pediatric patients.
• The diagnostic process for such cases can be lengthy and resource-intensive.
• Identifying MSBP early can avert unnecessary medical interventions and associated healthcare costs.

Implications:

• Healthcare providers, especially otolaryngologists, should maintain a high index of suspicion for MSBP in cases of unusual nasal pathology.
• Prompt diagnosis and intervention for MSBP can significantly improve patient outcomes and reduce healthcare system burden.
• Further research into the recognition and management of MSBP in otolaryngology is warranted.