Munchausen Syndrome by Proxy – A Rare but Real Type of Abuse

Abstract

Munchausen by proxy is a rare form of abuse that presents a significant risk of morbidity and mortality for the child, with the mother being responsible for the vast majority of cases. We describe the clinical case of a 2-year-old boy admitted by fever, vomits, diarrhoea and refusal to feed. During hospitalization he started vomiting with blood and was treated accordingly. On the night of the planned discharge he started with sleepiness, petechiae dispersed throughout the trunk and gross haematuria, and a thorough etiological investigation was done. Later on, he had another episode of sudden and transient miosis, sweating, absence of reactivity and haemolysis with alterations of the coagulation tests - Munchausen syndrome by proxy was suspected. Samples of blood, urine, vomit and food found near the child's bed were then collected and sent to analysis. The results of the samples, revealed toxic levels of isopropanol – a product normally used for hand desinfection. During the hospitalization, it was discovered that the mother had a past history of mental disease. Isopropanol intoxication is relatively frequent because of its easy accessibility. Symptoms involve the gastrointestinal tract, the central nervous system (CNS), and the cardiovascular system at higher doses. It is important to reinforce the idea of ​​considering the suspicion of Munchausen syndrome due to the presence of children with supposed symptoms that do not allow to consolidate a clear clinical diagnosis, the lack of response to the treatments implemented and the repeated demand for assistance in different health institutions.