Difficult diagnosis of factitious disorder

Area of Science:

• Ophthalmology
• Pediatric Medicine
• Child Abuse Research

Background:

• Factitious disorder imposed on another (FDIA) is infrequently documented with primary ocular symptoms.
• Ocular manifestations of FDIA pose diagnostic challenges, often leading to delayed or incorrect diagnoses.

Observation:

• An infant presented with recurrent periorbital cellulitis, discharge, and seizure-like episodes over 14 months.
• The infant underwent multiple treatments and an enucleation due to complications from unexplained symptoms.
• Persistent corneal perforations and apnoeic episodes complicated the infant's hospital stay.

Findings:

• Continuous EEG and video monitoring confirmed maternal infliction of physical harm.
• The diagnosis of factitious disorder imposed on another was established.
• The case resulted in the infant's bilateral blindness.

Implications:

• This case underscores the critical need for heightened suspicion of FDIA in pediatric cases with unusual or persistent symptoms.
• Early recognition and intervention are crucial to prevent severe, irreversible harm in victims of medical child abuse.
• Ophthalmologists and pediatricians must collaborate to identify and manage FDIA presenting with ocular findings.