The woman’s case record<\/a>, published this week in the New England Journal of Medicine, documents the thorough investigation of her dramatic condition. Doctors’ initial alarm at her symptoms led to puzzlement as inconsistencies and oddities piled up.<\/p>\nIt began when the woman presented to another hospital complaining of abdominal pain, jerking motions in her right arm and leg that she worried were seizures, as well as confusion, agitation, a rash on her chest, and a dislocated jaw bone. She told doctors at that hospital that she had a history of acute intermittent porphyria and that her symptoms matched previous flares of the condition.<\/p>\n
Porphyrias are rare disorders caused by genetic mutations that are usually inherited. The mutation affects an enzyme involved in turning compounds called porphyrins and porphyrin precursors into heme, which makes up hemoglobin, the iron-containing red protein in blood responsible for transporting oxygen. In people with porphyrias, the heme precursors build up, causing disease that can present as abdominal pain, arm and leg pain, paresthesia, weakness, and tachycardia.<\/p>\n\n Advertisement <\/span> <\/p>\n<\/aside>\nThe woman was admitted to the first hospital and began receiving treatment. But, the hospital was short on hemin\u2014the standard treatment for porphyria\u2014so she was transferred to Massachusetts General.<\/p>\n
There, she told doctors a similar story, and they began treating her with hemin and other drugs, including morphine for the pain. She told doctors she was 25, though they noted in her records that she appeared older. She told them she had been diagnosed with porphyria 13 years ago and that the condition ran in her family. Her maternal grandmother had the condition, and one of her seven siblings was a silent carrier. She also noted that though she had been born in New England, she moved to the United Kingdom 15 years ago and was only in the area at the time to visit family.<\/p>\n
Oddities<\/h2>\n During the next two days, oddities started piling up. Despite doctors giving her the standard treatment for porphyria, her symptoms didn’t improve. And her urinary PBG and porphyrin levels\u2014which are typically elevated in cases of porphyria\u2014were normal.<\/p>\n
The doctors began to doubt that porphyria was behind the woman’s symptoms. Instead, they considered bowel obstruction, biliary colic, appendicitis, or pancreatitis that could explain the abdominal pain. They thought about a medication or toxin, such as lead poisoning, causing some symptoms. There was also a consideration of withdrawal syndrome from being off morphine before her admission. But, the woman’s symptoms also weren’t improved by the morphine, ruling that possibility out. Nothing quite fit.<\/p>\n<\/p><\/div>\n
<\/br><\/br><\/br><\/p>\n
Food, Health, Science, Space, Space Craft, SpaceX<\/br>https:\/\/arstechnica.com\/science\/2023\/04\/woman-faked-elaborate-illness-doctors-say-in-report-on-factitious-disorder\/<\/a><\/br><\/br><\/p>\n","protected":false},"excerpt":{"rendered":"Source:https:\/\/arstechnica.com\/science\/2023\/04\/woman-faked-elaborate-illness-doctors-say-in-report-on-factitious-disorder\/ Diagnosing deception: How doctors solved a woman\u2019s dramatically faked condition 2023-04-29 21:48:36 Enlarge \/ A health care worker in a medical intensive care unit. Diagnosing medical conditions is not easy. Patients can have nondescript symptoms that could point to common problems as easily as rare or poorly understood ones. They can sprinkle in irrelevant […]<\/p>\n","protected":false},"author":1,"featured_media":30538,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","om_disable_all_campaigns":false,"pagelayer_contact_templates":[],"_pagelayer_content":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[103,32,26,33,105,36],"tags":[],"yoast_head":"\n
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![Enlarge<\/a> \/<\/span> A health care worker in a medical intensive care unit.<\/div>\n<\/figcaption><\/figure>\n](\"https:\/\/cdn.arstechnica.net\/wp-content\/uploads\/2023\/04\/GettyImages-1337944295-scaled.jpeg\"){kind=link}