Munchausen’s Syndrome With Rare Hematological Disorder, Systemic Mastocytosis: A Case Report
Case Report
Presenting Symptoms/Self-Reported Past Medical History | Work-Up Done in ER/Medical Floor | Positive Findings | Discharge Diagnosis |
---|---|---|---|
Cardiovascular | |||
Syncope | Troponin | QT prolongation in 2 out of 16 EKGs (on antipsychotic) | DVT |
MVP | EKG | DVT in upper limb | |
Long QT syndrome | Echo cardiogram | ||
Right-sided chest pain, palpitations | Chest X-ray | ||
Chest ultrasonography (USG) | |||
Hypertension | Chest CT | ||
Upper-extremity DVT | Holter monitor | ||
Pulmonary embolus | Venous duplex | ||
Clotted PICC line | V/Q scan | ||
Low protein C&S | Protein C & S, Factor V Leiden | ||
Endocrine | Osteoporosis: high dose of steroid | Secondary osteoporosis | |
Growth hormone deficiency, pituitary insufficiency, hypothyroidism | Cortisol | ||
Diabetes mellitus | Hormonal assays | Hyperprolactinemia (on antipsychotics) | |
Hyperprolactinemia | Osteomark | Hyperglycemia (on steroid) | |
Osteoporosis | Alkaline phos | ||
Blood glucose/Hb1c | |||
TSH/Free T4 | |||
Vit. D total/ D2/D3 | |||
Bone densitometry | |||
Neurological | |||
Syncope | Head CT | ||
Migraine | Head MRI | ||
Pituitary adenoma | Sinus CT | ||
Infectious | |||
Cellulitis | MRSA screening | Bone infection | Osteomyelitis |
Urinary tract infection | Chlamydia/ GC | Biopsy and scans | Septic arthritis |
Ankle abscess | Monospot | ||
Septic arthritis | Lyme antibody | ||
Osteomyelitis (OM) | Synovial fluid analysis | ||
Lymphangitis | Bone biopsy | ||
MRSA infection | WBC indium scan | ||
Myositis, dermatitis, | Pap smear | ||
Pseudomonal bacteremia | Upper- and lower-limb X-ray | ||
C spine/ L-spine/T-spine | |||
Culture: blood, urine, fungus, wound, anaerobes, bone, fluid, tissue, Acid Fast Bacteria (AFB) | |||
Gastrointestinal | |||
Abdominal pain | Liver-function test | ||
Jaundice | Fecal occult blood test | ||
PUD, GI bleed | 24-hour pH probe study | ||
Gastroenteritis | Gastric biopsy | ||
GERD | Abdominal and pelvic USG | ||
Rectal bleeding, | Abdominal and pelvic CT | ||
Cyclic vomiting | Gastric emptying test | ||
Allergy | |||
chronic angioedema | Allergy skin test | Asthma | |
Rhinitis | ANA ab | ||
Reactive airway disease | C4 | ||
Hives, urticaria, asthma | IgA | ||
Idiopathic anaphylaxis | Endomys IgA | ||
Psychiatry | |||
Depression, | Urine Tox | Eating disorder | |
anorexia and or bulimia, | Head CT | Depressive disorder | |
Adjustment reaction | Self-mutilation behavior | ||
Bipolar type 2 | Borderline PD | ||
Self-mutilation behavior | |||
Borderline PD | |||
Insomnia | |||
Posttraumatic stress disorder | |||
Generalized anxiety disorder | |||
Attention-deficient hyperkinetic disorder | |||
Musculo-Skeletal | |||
Osteoporosis | Culture: blood, fungus, wound, anaerobes, bone, fluid, tissue, AFB | Fractures bones on X-ray | |
Osteomyelitis | Lyme antibody | ||
Septic arthritis | Synovial fluid analysis | ||
Left posterior tibial tendonitis | Upper- and lower-limb X-ray | ||
Fractures of tibia and fibula | Joint X-ray/ MRI | ||
Groin-area stress fractures, costochondritis | L-spine/T-spine | ||
Back pain | Bone densitometry | ||
Recalcitrant left elbow | |||
Forearm lacerations | |||
Genitourinary | |||
Renal stone | UA | ||
Oligomenorrhea | Abdominal and pelvic USG | ||
Dysmenorrhea | Abdominal and pelvic CT | ||
Squamous metaplasia | PAP smear/cervical biopsy | ||
Respiratory | |||
Asthma | Chest X-ray/USG/CT | ||
Pneumonia | Polysomnography | Asthma | |
Pleural effusion | |||
Pneumothorax | |||
Sleep apnea | |||
Hemato-oncology | |||
Systemic mastocytosis | CBC, PBF | ||
Blood smear |
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