[Factitious disorder--fever and delayed wound healing].
METHODS
A 23-year-old woman was admitted to the department of rheumatology for detailed diagnostic tests for a suspected immune deficiency. Over the past 3 years, she has had repeated unexplained febrile episodes and impaired wound healing, which required permanent antibiotic treatment.


METHODS
Extensive tests initially showed no definitively diagnostic findings. Based on various clinical and inconsistencies in biochemic tests, the suspicion of a self-inflicted cause increased. In several interviews with a psychologist of the psychosomatic consultation service, the patient finally admitted manipulation by means of i. v. application of bacterially contaminated water.


METHODS
The self-inflicted injuries were interpreted as the consequence of a serious psychological trauma, as well as a self-healing attempt to prevent an emotional breakdown. The trust which the patient developed in her specialist carers after admitting the deception, made it possible to motivate her to continue psychotherapy.


CONCLUSIONS
If a factitious disorder is suspected, the doctor should not be too precipitous in confronting the patient without expression of empathy, but rather respect the self-inflicted injury as a measure of self-preservation. Such non-confrontational behavior on the part of the carer enables the patient to accept the offer of psychotherapy without losing face.
Fritzsche
K
K
Abteilung für Psychosomatische Medizin und Psychotherapie am Universitätsklinikum Freiburg, Hauptstr. 8, 79104 Freiburg. kurt.fritzsche@uniklinik-freiburg.de
Venhoff
N
N
Larisch
A
A
D000328:Adult; D005162:Factitious Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D005260:Female; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D010817:Physician-Patient Relations; D011613:Psychotherapy; D014945:Wound Healing / Q000276:immunology*