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Munchausen Syndrome in the Act of Creating and Enacting Macroscopic Hematuria

transfusion, that her anemia did not improve despite blood transfusion, and that during transfusion hematuria would begin again, led the authors to suspect Munchausen syndrome. On beginning detailed observation of her behavior during blood transfusion, we witnessed her using a dirty syringe ( fig. 1 ), which she had hidden on her person, to remove some of the transfusion blood and inject it into her own bladder, thus leading to the confirmed diagnosis. We diagnosed her Munchausen synWe report the rare experience of discovering a patient in the act of creating and enacting macroscopic hematuria and thereby reaching a confirmed diagnosis of Munchausen syndrome. The patient was a 27-year-old female. She presented complaining mainly of macroscopic hematuria. She had been treated for the same main condition by some previous physicians, and she had undergone a laparoscopic right nephrectomy under the diagnosis of arteriovenous malformation. Post-surgery, macroscopic hematuria continued and the cause of the hematuria remained unclear in spite of numerous examinations. The patient was treated with more than 200 units of packed red blood cell transfusion to treat severe anemia and frequently suffered from septicemia. At her own request, the patient attended our department. Despite various tests, the cause of the hematuria remained indeterminate, and she was subjected to repeated packed red blood cell transfusion and continued to experience septicemia. After a certain period of time, the patient’s behavior, including the facts that no organic disorder could be identified, that the patient experienced cumulative septicemia after blood transfusion, that she would close the curtains for long periods during Received: December 5, 2013 Accepted: December 10, 2013 Published online: February 27, 2014