Drug-Induced Undifferentiated Connective Tissue Disease in a Two-Year-Old Girl: A Manifestation of Factitious Disorder Imposed on Another (FDIA)

TL;DR

A two-year-old girl was found to have a fabricated illness by her caregiver, who administered a drug to induce symptoms resembling a connective tissue disease.

Contribution

This case highlights FDIA as a potential cause of unexplained recurrent fevers and inflammatory symptoms in children.

Findings

The patient's symptoms improved only after the caregiver was removed.

The caregiver admitted to administering pyrogenal to induce illness.

FDIA should be considered in cases of unexplained recurrent fever in children.

Abstract

Factitious disorder imposed on another (FDIA), formerly known as Munchausen syndrome by proxy (MSBP), constitutes a form of child abuse wherein a caregiver fabricates or induces illness in a person under their care or supervision. Here, we present a case of a two-year-old girl with signs and symptoms suggestive of undifferentiated connective tissue disease (UCTD) and probable autoinflammatory disease, which was a manifestation of FDIA. The patient manifested recurrent febrile episodes and presented with hepatosplenomegaly, elevated inflammatory markers, and mesangial proliferative glomerulonephritis. Regardless of extensive medical interventions, including corticosteroids and immunosuppressive therapy, the patient's condition failed to improve until the caregiver was isolated from the patient. Upon questioning, the caregiver admitted to having administered pyrogenal, an immunomodulator, to induce symptoms. This case highlights the challenges and difficulties of diagnosing and managing FDIA-associated illnesses, drawing attention to the importance of considering this diagnosis in cases of unexplained or recurrent fever in children.

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