Urinary calculi and Munchausen syndrome

• Published in: Archives de pédiatrie : organe officiel de la Société française de pédiatrie 1998-05, Vol.5 (5), p.517-520
• Main Authors: Absolut de la Gastine, G, Penniello, M J, Le Treust, M, Grujard, D, Guillois, B
• Format: Article
• Language: fre
• Subjects: Child; Humans; Male; Munchausen Syndrome - diagnosis; Urinary Calculi
• ISSN: 0929-693X
• DOI: 10.1016/S0929-693X(99)80317-0

Unlike the so-called Munchausen syndrome by proxy, which is a form of child abuse, Munchausen syndrome is seldom reported in pediatric literature. Anthony, an 8.5-year-old child, was referred because he passed several urinary stones. Although biological findings and urinary tract ultrasonography were normal, intravenous pyelogram showed a round area of decreased density in front of the anterior urethra, which disappeared from postmicturation X-ray. For a 1 month period, the child passed 20 stones without intense pain. After undergoing an appendectomy, he was readmitted for left lumbar pain which disappeared after passage of a stone. He spent the following 10 months without any complaint. On later re-admission with similar symptoms, Munchausen syndrome was suspected because of the discrepancy arising from the emission of stones on one hand and the absence of nephritic colic, of hematuria and of urinary tract dilatation on the other hand. Diagnosis of Munchausen syndrome was confirmed by chemical analysis which reported that samples were in fact ordinary pebbles and by child's confession, during interrogation without his parents, to having introduced the pebbles into his urinary tracts. When unusual clinical features are present in children, it is necessary to evoke the Munchausen syndrome which can be likened to a distress signal revealing the presence of psychological disorders.