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Advances in dermatology and venereology Acta Dermato-Venereologica
Extraordinary Findings in a Case of Self-inflicted Cutaneous Lesions
Maria Julia CANUTO 1, Ana Claudia Grizzo Peres MARTINS 1, Alexandre Jack DWAN 2, Cyro Festa NETO 1 and Marcello Menta Simonsen NICO 1 * Departments of 1 Dermatology, and 2 Psychiatry, Medical School, University of São Paulo, Rua Itapeva 500, 3A, CEP-01332-000 São Paulo, Brazil. * E-mail: mentanico @ hotmail. com Accepted Apr 18, 2017; Epub ahead of print Apr 19, 2017
Factitious dermatologic disorder( FDD), formerly called dermatitis artefacta or factitious dermatitis, is a disorder of self-induced behavior( 1). FDD can be defined as any condition that involves self-inflicted skin lesions for which the patient denies all responsibility due to extant personality disorder( 2, 3). Patients induce lesions to fulfill an unconscious psychological need( 1). The clinical profile of FDD varies significantly and depends on how the patient traumatizes the skin. The lesions observed can include erosions, ulcers, eschars, blisters, nodules that follow injection of foreign material( 4), and mutilation( 1, 2).
We present a case of FDD who showed extraordinary radiological findings. In addition, during a psychiatric follow-up, the patient revealed her motivations in producing the lesions, prompting a discussion on her psychopathology.
CASE REPORT
A 60-year-old married woman presented with cutaneous lesions on her left lower limb that had been present for
Fig. 1. Multiple cutaneous ulcers.
6 months. Her husband, who was concerned about her complaints – the patient claimed to have been possessed by evil spirits – had taken her to the hospital. Since the initial presentation, the patient had been examined in many hospitals, stating that no doctor could identify the cause of her ailments.
An examination showed several irregularly shaped, well-demarcated, shallow cutaneous ulcers on the left leg and calf, with no signs of inflammation( Fig. 1). The patient affirmed that the lesions developed suddenly, without any preexisting symptoms. FDD was promptly suspected; the lower limb was X-rayed, upon insistence of the patient. On the X-ray, radio-opaque images of many intact and broken sewing needles could be seen, residing at various depths of the lower limb soft tissues( Fig. 2). The patient claimed that no person had inserted the needles into her body, and she was certain that they were the result of witchcraft. Her husband supported this theory.
Fig. 2. Left lower leg radiograph: lateral view( left), and front view( right) showing multiple self-embedded needles.
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2680 Acta Derm Venereol 2017; 97: 967 – 968