The term Munchausen syndrome was first used in 1951 after Baron von Münchhausen, a German nobleman known for his exaggerated storytelling. DSM-5 refers to it as factitious disorder imposed on self: “falsification of physical or psychological signs or symptoms, or induction of injury or disease, (…) in the absence of obvious external rewards”.

To report a case of Munchausen syndrome and highlight the impact on its physical and psychiatric approaches.

Description of a clinical case based on medical records and a brief review on Munchausen syndrome.

A 57-year-old female, with no previous psychiatric history, was evaluated by Psychiatry for complaints of depression with suicidal ideation. She reported family conflicts and a list of medical conditions and surgical interventions. According to the patient she was waiting for a cardiac transplant and said she had type 1 diabetes, myasthenia gravis, hepatic steatoses, dyslipidemia, hyperuricemia, mitral valve prolapse and was submitted to a thymectomy and cervical herniated disc surgery. She was on many different prescription pills. Even though she had blocked the access to her clinical records in other institutions, at our hospital she had multiple admissions to the emergency room, numerous follow-up appointments of different specialties and several allergies documented. She displayed many incoherencies throughout the interview, had a circumstantial speech and exuberant appearance.

Munchausen syndrome remains a challenging diagnosis to physicians. This condition is not only associated with significant morbidity and mortality, but also with unnecessary tests and procedures, iatrogenesis, prolonged hospitalizations and increased health costs.

No significant relationships.

Patient G. D. born in 1975, trained as a textile worker, unemployed, married, mother of three children. The current hospitalization was due to suicide attempts and manifestation of depressive symptoms after a stressful event.

Our diagnostic dilemma was whether it concerns:

1. - depressive disorder with psychotic symptoms

2. - adjustment disorder in people with personality disorder

After applying diagnostic procedures and observations during individual psychotherapy sessions, as well as the response to a given therapy, psychotic depression is excluded. The stories provided from the patient were in conflict since they have changed in contact with different therapists in the same department, why we decided to consult other professionals from other departments at which the patient apparently was treated.

In this disorder the patient is aware that he is exaggerating and faking illness, but in core of the disease is irresistible urge for pointing attention, and the cause is most likely a lack of love and affection in childhood.

In psychoterapic process was included family therapist also. Family therapist confronted patient with family members, which resulted in a real insight into the mental state and allowed us to confirm a diagnose of histionic personality disorder with tendency to pathological lying- Munchausen syndrome.

In this presentation, we wanted to point out the necessity of cooperation of a psychiatrist with other specialists, considering that patients with this disorder are prone to change therapists, hospitals and faking the results of diagnostic tests.

To review the diagnosis of Munchausen syndrome by proxy, a factitious disorder, in which symptoms are induced or feigned, usually in a child, by the caregiver. The involved caregiver seeks to gain attention or sympathy and often has a psychological need to maintain the sick role. We highlight the diagnostic difficulties and factors that may help with diagnosis in an otolaryngology setting.

We present the case of Munchausen syndrome by proxy presenting with hearing loss in a five-year old boy, who was diagnosed eight years after his initial presentation. A literature review of Munchausen syndrome by proxy cases presenting with ENT symptoms is provided.

Munchausen syndrome by proxy is a diagnosis that otolaryngologists should be aware of, particularly where recurrent or persistent illnesses in children, especially those involving otological symptoms, are refractory to the usual treatments.