以伪装热为表现的儿童孟乔森综合征10例病例系列报告

10 cases of Munchausen syndrome manifested as factitious fever in children:A case series report

背景以伪装热为表现的儿童孟乔森综合征病例常就诊于精神科、心理科以外的其他科室,这些科室医生对该病认识不足,患儿很难得到及时和正确的诊治,发病率可能被低估。目的 总结以伪装热为表现的孟乔森综合征儿童的临床资料,提高对该病的认识。设计病例系列报告。方法 回顾性纳入2022年1月至2024年1月在3个医院诊断以伪装热为表现的孟乔森综合征的连续住院病例。通过各医院管理信息系统采集病例性别、发病年龄、病程,就诊经历及治疗史,发热特征,体格检查,辅助检查等临床资料。主要结局指标发热特征。结果 10例患儿进入本文分析,均为女童,起病年龄12(10~14)岁,病程6.3(1~18)个月。门诊频次平均8(4~12)次,住院频次平均3.5(2~5)次,就诊医院数平均3.5(3~5)家。均有反复行糖皮质激素、抗菌药物治疗史且均无疗效。均在短时间内体温达到高热(39.0~40.2℃),约5 min内体温恢复正常;6例偶有头晕,其中伴头痛2例,伴腹痛1例;发热前均无畏寒及寒战,时间无规律性;体温恢复正常时无出汗反应。发热前后皮肤体感温度、脉搏、心率、呼吸频次均未见变化。精神和食欲均正常;体重轻度增加3例,余病例均未见下降;均无阳性体征。辅助检查均未见异常。单亲家庭环境4例,父母长期争执、吵闹5例,留守儿童1例。均转至心理科进行干预,随访时间8(5~12)个月,未见类似发热发作,也无因其他症状就诊者。结论 以伪装热为表现的儿童孟乔森综合征好发于女性儿童/青少年,多次反复求治于不同医院,体温可在3~8 min内达到高热,约5 min内恢复正常,发作时无发热时典型病理生理过程变化,实验室检验和辅助检查结果无异常;虽然病程较长,但无疾病状态改变。

Background Children with Munchausen syndrome characterized by factitious fever are often treated in other departments other than psychiatry and psychology.Doctors in these departments do not know enough about Munchausen syndrome.Therefore,it is difficult for children to get correct diagnosis and treatment timely,and the incidence rate may be underestimated.Objective To summarize the clinical characteristics of children with Munchausen syndrome manifested as factitious fever,and to improve the understanding.Design Case series report.Methods Retrospective analysis was performed for consecutive hospitalized cases diagnosed with Munchausen syndrome presenting with factitious fever from January 2022 to January 2024 at nephrology,rheumatology and immunology departments of Children's Hospital of Jiangnan University,Children's Medical Center of Taihe Hospital Affiliated to Hubei Medical University,and the Rheumatology Department of Anhui Children's Hospital.Clinical data were collected from the management information system of each hospital,including gender,age at onset,disease course,medical history,characteristics of the fever,physical examination,and auxiliary examination.Main outcome measures Characteristics of the fever.Results Ten cases were included in this analysis,all of whom were girls with an onset age of 12(10-14)years and a disease course of 6.3(1-18)months.The average number of outpatient visits was 8(4-12)times,the average number of hospitalizations was 3.5(2-5)times,and the average number of hospitals visited was 3.5(3-5).All had a history of repeated glucocorticoid and antibiotic treatments without efficacy.The body temperature of all patients rose to high fever(39.0-40.2°C)within a short period and returned to normal within about 5 minutes.Six cases occasionally experienced dizziness,including two with headaches and one with abdominal pain.There was no shivering or chills before the fever,and the timing was irregular.There was no sweating reaction when the temperature returned to normal.There were no changes in skin temperature,pulse,heart rate,or respiratory rate before and after the fever.Mental state and appetite were normal.Three cases had a slight increase in weight,while the others showed no decrease.No positive signs were found.Auxiliary examinations were all normal.Four cases were from single-parent families,five had long-term parental conflicts,and one was a left-behind child.All were referred to the psychology department for intervention,with a follow-up period of 8(5-12)months.No similar fever episodes or other symptoms were observed during follow-up.Conclusion Munchausen syndrome presenting with factitious fever is more common in female children/adolescents,often seeking treatment at multiple hospitals repeatedly.The body temperature can reach high fever within 3-8 minutes and return to normal in about 5 minutes.There are no typical pathophysiological changes during episodes,and laboratory and auxiliary examination results are normal.Despite a prolonged disease course,there are no changes in disease status.