title: Factitial illness mimicking rheumatic disease with panniculitis.
abstract: Factitial disorders can present with a wide spectrum of clinical features and might be overlooked. We identified two patients believed to have factitial disorders mimicking panniculitis at one medical center within 15 months. Both were females in their early forties who had long histories of cutaneous ulcerations, recurrent cellulitis, abscesses, atrophy, and scarring with sparing of inaccessible body areas. They had a) undergone surgical interventions during multiple hospitalizations, b) demonstrated no response to apparently appropriate medical management, c) had thick charts, clinical depression, "hollow" histories, and borderline personalities, and d) exhibited "peregrination" and "laparotomaphilia migrans." Their biopsies suggested amorphous birefringent material of exogenous origin on polarized light microscopy. Factitial disease is an underrecognized clinical syndrome. This diagnosis can be established when it is considered and when thoughtful evaluation is undertaken; this disorder may be amendable to management if patients return for care.
authors.affiliation: Currently Post-Doctoral Fellow, Division of Clinical Immunology, Allergy, and Rheumatology, Department of Medicine, University of Rochester, School of Medicine, Rochester, New York. From the Departments of Medicine (S.M.C., R.S.P.), Pathology (E.B., M.K., R.R.R.), Psychiatry (R.S.), and Surgery (P.C.), Saint Barnabas Medical Center, Livingston, New Jersey; University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Livingston, New Jersey (R.S.P.).
authors.forename: S M
authors.initials: SM
authors.lastname: Castro
authors.forename: E
authors.initials: E
authors.lastname: Berman
authors.forename: P C
authors.initials: PC
authors.lastname: Chang
authors.forename: M
authors.initials: M
authors.lastname: Kintiroglou
authors.forename: R R
authors.initials: RR
authors.lastname: Rickert
authors.forename: R
authors.initials: R
authors.lastname: Sostowski
authors.forename: R S
authors.initials: RS
authors.lastname: Panush