'Munchausen syndrome': a forgotten diagnosis in the spine.
To present the case of a patient with Munchausen's syndrome who underwent multiple surgeries in the spine before the diagnosis was made and, therefore, to highlight the importance of this obscure condition that can result in unnecessary surgical treatment.



A 44-year-old businesswoman presented with multiple episodes of low back pain and weakness in both lower limbs over past 11 years. Past history consisted of multiple hospitalizations, and three surgeries on her lumbar spine at different hospitals, with dramatic improvement in symptoms being reported each time after surgery. Clinical examination showed inconsistent and nonspecific neurological findings. Imaging studies like X-rays, magnetic resonance imaging, and all neurophysiological studies were within normal limits.



Multi-disciplinary evaluation by a team of orthopedicians, neurologist and psychiatrist and rehabilitation specialists diagnosed it as 'Munchausen syndrome'. Only one report of this fictitious disease in spine was found in review of literature (Association AP, Diagnostic and statistical manual of mental disorders: DSM-IV-TR(®), 2003).



A history of multiple surgical interventions at multiple hospitals, often followed by dramatic improvement and then relapse, should trigger a suspicion of Munchausen syndrome, particularly in the scenario of normal imaging studies. Diagnosing this rare condition in spine is key to avoid unnecessary surgery.
Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India. kedarorth@gmail.com.
Kedar Prashant
0000-0001-6257-717X
KP
Padhye
Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India.
Kenny S
KS
David
Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India.
Saumil Y
SY
Dholakia
Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India.
Vivek
V
Mathew
Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, 632004, India.
Yuvaraja
Y
Murugan
D000328:Adult; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology; D008159:Lumbar Vertebrae / Q000601:surgery; D009110:Munchausen Syndrome / Q000175:diagnosis* / Q000523:psychology*; D018908:Muscle Weakness / Q000523:psychology; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D012008:Recurrence
Fictitious disorder; Lumbar spine; Munchausen syndrome; Normal imaging