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Persistent ulcer of the knee

N Nishijima¹, T Yamamuro, Y Seto

¹Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Japan.

Bulletin (Hospital for Joint Diseases (New York, N.Y.))

|January 1, 1993

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A persistent knee ulcer in a teen resolved with a plaster cast after surgical treatments failed. This case suggests Munchausen syndrome may have been the underlying cause.

Area of Science:

Orthopedics
Psychiatry
Dermatology

Background:

A 15-year-old female presented with a chronic, recurring knee ulcer.
Previous surgical interventions, including intraarticular knee arthrodesis, were unsuccessful in healing the ulcer.

Observation:

The ulcer persisted despite multiple debridements and a free musculocutaneous flap.
Application of a plaster cast proved to be the most effective treatment.

Findings:

The unusual treatment response suggests a non-organic etiology for the persistent ulcer.
The clinical presentation is highly indicative of Munchausen syndrome.

Implications:

This case highlights the importance of considering psychogenic causes in refractory physical symptoms.

Related Experiment Videos

Plaster cast immobilization may be an effective, albeit unconventional, treatment for factitious disorders manifesting as ulcers.

Further research into the presentation and management of Munchausen syndrome in adolescents is warranted.