ABSTRACT

Munchausen syndrome by proxy is a form of abuse in which an adult, usually the mother, deceives health workers by exaggerating, falsifying or directly inducing psychological or physical symptoms in the child victim for psychological gratification. In 2013, the American Academy of Pediatrics coined the term ‘caregiver-fabricated illness in a child’ to describe this form of child abuse. A 7-year-old girl had many encounters with health workers over a period of 4 years and presented with evolving clinical features including refractory seizures and red urine for which she was followed up as a case of acute intermittent porphyria. She was later discovered to be the victim of chronic monocrotophos organophosphate poisoning by her mother. If all medical staff who manage children are to avoid becoming inadvertent participants in medical child abuse, this case report is an important reminder that a high index of suspicion is warranted in cases which present a diagnostic dilemma and who respond unexpectedly to treatment.

Abbreviations AIP: Acute intermittent porphyria; APSAC: American Professional Society on the Abuse of Children; ASM: anti-seizure medication; CFIC: caregiver-fabricated illness in a child; CT: computed tomography: DVT: deep vein thrombosis; EEG: electroencephalogram: ESR: erythrocyte sedimentation rate; HDW: high-dependency ward; ICU: intensive care unit; LFT: liver function test; MBP: Munchausen syndrome by proxy; NICU: neonatal intensive care unit; RFT: renal function test; TB: Tuberculosis; UTH-CH: University Teaching Hospitals Children’s Hospital.

摘要

Munchausen 代理综合症是一种虐待形式，其中成年人，通常是母亲，通过夸大、伪造或直接诱导儿童受害者的心理或身体症状来欺骗卫生工作者，以获得心理满足。2013 年，美国儿科学会创造了“儿童看护人制造的疾病”一词来描述这种虐待儿童的形式。一名 7 岁女孩在 4 年内多次与卫生工作者接触，并出现不断演变的临床特征，包括顽固性癫痫发作和红色尿液，随后作为急性间歇性卟啉症病例进行随访。后来她被母亲发现是慢性久效磷有机磷中毒的受害者。如果所有管理儿童的医务人员要避免无意中成为虐待儿童的参与者，

缩写AIP：急性间歇性卟啉症；ASPAC：美国虐待儿童专业协会；ASM：抗癫痫药；CFIC：照顾者制造的儿童疾病；CT：计算机断层扫描：DVT：深静脉血栓形成；EEG：脑电图： ESR：红细胞沉降率；HDW：高依赖病房；ICU：重症监护室；LFT：肝功能检查；MBP：代理蒙乔森综合征；NICU：新生儿重症监护室；RFT：肾功能检查；结核病：结核病；UTH-CH：大学教学医院儿童医院。