Chocs septiques à répétition chez une patiente de 36 ans et syndrome de Münchhausen : dilemme diagnostique et impasse thérapeutique

Unknow and rare, often unsuspected, Münchausen's syndrome is a chronic factitious illness, characterized by self-produced symptoms with sometimes severe complications without any goal except to challenge the physicians and gain their consideration. Münchausen's syndrome may mimic different clinical features as acute abdominal pain, haemorrhagic lesions, factitious fever, repeated episodes of bacteremia, cutaneous pathomimia and may lead to unnecessary treatment, invasive diagnostic studies with their inherent risk of complications or fatal outcome. The investigation of the psychopathology of these patients and their treatment is difficult and even impossible because most of them refuse psychiatric exploration and therapy. We report the case of a 36-year-old woman, admitted monthly during half a year to the emergency department due a repeated bacteremia and recurrent septic shock. Multiple blood culture were positive for several strains of bacteria, including Staphylococcus aureus, Escherichia coli, Bactéroïdes fragilis, Enterococcus faecium and faecalis and many procedures and tests were performed without pathologic findings. During this year, the suspicion had arisen that the patient had inoculated herself with contaminated material to produce sepsis but she'd never admitted this fact, never accepted the diagnosis of Münchausen's syndrome and didn't permit a therapeutic approach. It's to be feared that new recurrences will occur again.