Caustic esophagitis in two siblings:Munchausen syndrome by proxy

Abstract

Background and aim: Recurrent corrosive esophagitis is a rare condition among children and may be due to child abuse. The Munchausen Syndrome by Proxy (MSBP) is special form of child abuse with variety of symptoms. It has challenging diagnostic process and needs a high clinical suspicion. When it is identified by physician, institutional child protection team must involve into the management of the case. Case report: We present the two siblings with recurrent esopahigitis. One of them died due to severe gastrointestinal bleeding. Other had severe esophageal stricture and oral lesions. Their mother fed both of them with caustic material at various time intervals. Both babies were treated in our hospital several times with the admission of their mother. Conclusion: This is the probably the first case report of Munchausen Syndrome by Proxy (MSBP) with caustic material ingestion of two siblings. Determining the exact cause of such cases is very difficult and physician must suspect child abuse in this situation.

Keywords

• Reccurent caustic esophagitis, Child abuse, Munchausen Syndrome

References

1. Stirling J & committee on child abuse and neglect. Beyond Munchausen syndrome by Proxy: Identification and treatment of child abuse in a medical setting. pediatrics 2009; 119: 1026-1030.
2. Clin B, Ferrant O, Dupont C, Papin F. Recurrent caustic esophagitis: a clinical form of Münchausen syndrome by proxy. Child Abuse Negl 2009; 33: 293-295.
3. Awadallah, N, Vaughan, A, Franco, K, Munir, F, Sharaby, N, Goldfarb J. Munchausen by proxy: A case, chart series, and literature review of older victims. Child Abuse Negl 2005; 29: 931–941.
4. de Jong AL, Macdonald R, Ein S, Forte V, Turner Al. Corrosive esophagitis in children: a 30-year review. Int J Pediatr Otorhinolaryngol 2001; 57: 203-211.
5. Dogan Y, Erkan T, Çokugras FC, Kutlu T. Caustic gastroesophgeal lesions in childhood: An analysis of 473 cases. Clin Pediatr 2006; 45: 434-438.
6. Lamireau T, Rebouissoux L, Denis D, Lancelin F. Accidental caustic ıngestion in children: Is endoscopy always mandatory? J Pediatr Gastroenterol Nutr 2001; 33:81-84.
7. Lewis, W. Detecting fabricated or induced illness in children: Covert video surveillance can protect children and parents if rules are clear. BMJ 2005; 331:1144.
8. Alexander R, Smith W, Stevenson R. Serial Munchausen syndrome by proxy. Pediatrics 1990; 86:581-5.

9. Southall DP, Plunkett MC, Banks MW, Falkov AF, Samuels MP. Covert video recording of life-threatining child abuse: Lessons for child protection. Pediatrics 1997; 100: 735-760.
10. Hall DE, Eubanks L, Meyyazhagan LS, Kenney RD, Johnson SC. Evaluation of covert video surveillance in the diagnosis of Munchausen syndrome by Proxy: Lessons from 41 cases. Pediatrics 2000; 105:1305- 1312.