title: Munchausen by proxy syndrome mimicking systemic autoinflammatory disease: case report and review of the literature.
abstract: BACKGROUND
  Systemic autoinflammatory diseases (SAIDs) represent a growing number of monogenic, polygenic or multifactorial disorders that are often difficult to diagnose.
  
  
  METHODS
  Here we report a patient who was initially erroneously diagnosed and treated for SAID. Symptoms consisted of recurrent fever, erythematous and/or blistering skin lesions, angioedema, susceptibility to bleeding, external ear infections and reversible anisocoria in the absence of laboratory evidence of systemic inflammation. After two and a half years of extensive diagnostic work-up and multiple empirical therapies, a final diagnosis of Munchausen by proxy syndrome (MBPS) was established.
  
  
  CONCLUSIONS
  The diagnosis of SAID needs to be carefully reassessed if measurable systemic inflammation is missing, and MBPS should be included in the differential diagnosis.
authors.affiliation: Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, Bld. W30, D-48149, Muenster, Germany. helmut.wittkowski@ukmuenster.de.
authors.forename: Helmut
authors.identifier: http://orcid.org/0000-0001-6038-7460
authors.initials: H
authors.lastname: Wittkowski
authors.affiliation: Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, Bld. W30, D-48149, Muenster, Germany.
authors.forename: Claas
authors.initials: C
authors.lastname: Hinze
authors.affiliation: Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany.
authors.forename: Sigrid
authors.initials: S
authors.lastname: Häfner-Harms
authors.affiliation: Department of Dermatology, University Hospital Muenster, Muenster, Germany.
authors.forename: Vinzenz
authors.initials: V
authors.lastname: Oji
authors.affiliation: Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Masjosthusmann
authors.affiliation: Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Monninger
authors.affiliation: Department of Ophthalmology, University Hospital Muenster, Muenster, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Grenzebach
authors.affiliation: Department of Paediatric Rheumatology and Immunology, University Children's Hospital Muenster, Albert-Schweitzer-Campus 1, Bld. W30, D-48149, Muenster, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Foell
mesh_terms: D002675:Child, Preschool; D003937:Diagnosis, Differential; D056660:Hereditary Autoinflammatory Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D016735:Munchausen Syndrome by Proxy / Q000175:diagnosis*
keywords: Autoinflammation; Differential diagnosis; Münchhausen by proxy syndrome (MBPS); Systemic autoinflammatory disease (SAID)