Recurrent caustic esophagitis: A clinical form of Munchausen syndrome by proxy. Benedicte Clin, Ophelie Ferrant, Claire Dupont, Frederique Papin. Child Abuse Negl 2009;33:293-295. (from Caen, France)
Review from Autumn 2009 issue
This is a case report of a nine-month-old infant brought for care for sudden onset of inflammatory oral and pharyngeal lesions associated with vomiting 20 minutes after a meal of baby food. Physical exam revealed significant edema of the inferior lip, palate, and tongue. The tongue was black and there was drooling and salivation with dysphagia.
Skeletal survey was normal and all tests administered in the hospital were negative. Esophagoscopy done nine days later, however, showed signs of cicatricial mucosal injury associated with telangiectasia; the endoscopist called this caustic esophagitis.
With treatment, the infant recovered. While the infant was still in the hospital, however, a second identical episode occurred. Munchausen syndrome by proxy (MSBP) was suspected and the child was transferred to Regional University Hospital.
Psychiatric evaluation of the mother revealed a history of self-mutilation from the age of 17. She confessed to having, on two occasions, mixed an antimescale agent in her child’s food. The infant’s mother was prosecuted and under French law she received a nine-year prison term.
Reviewed by Robert M. Reece, M.D.
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