Objectives: To present a case of Münchhausen syndrome through exacerbation of SIADH (syndrome of inappropriate secretion of antidiuretic hormone syndrome).

Background and aims: Münchhausen syndrome or factitious disorder imposed on self (FD) is characterized by feigning, falsifying or inducing medical, psychological and behavioral signs and symptoms, not motivated by obvious external rewards or incentives. Due to the deceptive behaviors involved, it presents as a diagnostic and management challenge.

Materials and methods: Presentation of a case study, supported by a review of the literature with the key-words “Münchhausen syndrome” and “factitious disorder”.

Results: A 73 year old woman with history of SIADH and dysthimic disorder presented at the ER after discontinuation of antidepressives and with multiple unspecific complaints, nausea and anxious mood. Her caretaker didn´t accept any of the suggested therapeutic options for fear of subsequent imbalance of sodium levels. The patient was admitted in the Psychiatry department for reintroduction of antidepressive therapy.
One week after admission sodium levels changed from 132 to 115 mmol/L. All medication that could cause hyponatremia was changed, including a trial with placebo. Other possible causes for hyponatremia were excluded. Despite this, sodium levels only improved after free water restriction imposed by the nursing staff, which worsened the patient’s behavior and complaints, supporting the diagnosis of FD. 

Conclusions: FD is one of the most challenging disorders and is associated with a heavy impact on unnecessary investigations, treatments and hospital admissions. Its early detection is crucial in order to limit waste of healthcare resources and harm to patients

A CASE OF MÜNCHHAUSEN SYNDROME THROUGH EXACERBATION OF SIADH