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This case report details a rare instance of Munchausen by proxy where a mother used anticoagulant medication to harm her child, leading to a hemorrhagic disorder. This highlights a critical form of child abuse that requires careful medical consideration.
Area of Science:
- Pediatrics
- Toxicology
- Child Psychiatry
Background:
- Munchausen by proxy (MBP) involves inducing or fabricating illness in a child.
- Covert anticoagulant ingestion is a known form of adult self-harm or abuse.
- This case presents a unique overlap of these conditions in a pediatric patient.
Purpose of the Study:
- To report a novel case combining features of Munchausen by proxy and covert anticoagulant ingestion in an infant.
- To emphasize the diagnostic challenges and considerations for this rare form of child abuse.
- To highlight the importance of considering induced hemorrhagic disorders in pediatric differentials.
Main Methods:
- Case report of an 11-month-old female presenting with hemorrhagic otitis media and subcutaneous nodules.
- Diagnostic workup included coagulation studies and serum warfarin level.
- Psychiatric evaluation of the mother revealed characteristics of MBP and anticoagulant malingering.
Main Results:
- Coagulation studies indicated Vitamin K deficiency consistent with anticoagulant ingestion.
- Serum warfarin levels confirmed the presence of the anticoagulant.
- The mother exhibited psychological traits associated with Munchausen by proxy and anticoagulant abuse.
Conclusions:
- This case illustrates the dangerous combination of Munchausen by proxy and anticoagulant poisoning in a child.
- Healthcare providers should consider induced hemorrhagic disorders in the differential diagnosis of unexplained bleeding in children.
- Prompt psychiatric intervention for the perpetrator and protective placement for the child are crucial.
Abstract:
Munchausen by proxy has been reported involving children who have been given various drugs or toxins. In addition, there is a body of adult literature regarding covert anticoagulant ingestion. This is a case of an 11-month-old female who appears to combine features of both of these syndromes. This child presented with an acute left hemorrhagic otitis media. The physical examination was unremarkable except for the following: weight, fifth percentile; left external auditory canal filled with blood with the right external canal and tympanic membrane being normal; and several scattered 1 X 2 cm firm, movable, nontender, purple nodules on extremities, chest and forehead. The coagulation studies were consistent with Vitamin K deficiency secondary to anticoagulant ingestion. A serum warfarin study confirmed our suspicions. The mother was noted to have a dependent relationship with her child and characteristics of those involved in Munchausen by proxy: falsifying information and thwarting medical assessment. In addition, she displayed some of the characteristics found commonly in anticoagulant malingerers. She was depressed, with limited medical knowledge, and had access to warfarin. The mother was admitted for inpatient psychiatric care and the patient placed with an extended family member. This case report describes the use of an anticoagulant to induce illness in a child by a psychologically ill mother. This form of child abuse must be considered in the differential diagnoses of hemorrhagic disorders.