[An infant with unexplained epilepsy]

Abstract

A 6-month-old male infant with an unremarkable past medical history was admitted to the emergency department in an epileptic state. The seizures were resistant to treatment with conventional drugs. The child was sedated, intubated and admitted to the intensive care department. Despite extensive investigations no underlying disease was found. The seizures persisted and the child was repeatedly admitted to the hospital. Four months after the first presentation, ventricular fibrillation occurred from which the child was successfully resuscitated. His stomach appeared to contain a disinfectant and a severe ethanol-intoxication was found, leading to the diagnosis "Munchausen syndrome by proxy". The incidence of this syndrome is underestimated. Recognition of this potentially fatal phenomenon is often difficult, resulting in a delay in diagnosis. Paediatricians and general practitioners should be aware of this syndrome in children presenting with an unusual disease or an unusual medical history reported by the parents or care providers.