Recurrent factitious subcutaneous emphysema: report of a complex case in a young woman and a literature review.

Subcutaneous emphysema (SE) can be caused by antecedent trauma, surgery, rupture of visceral organs or serious infection from gas-forming microorganisms. Factitious SE is very rare; only about a dozen cases have been reported. Most patients had an underlying psychiatric condition or relevant history. The diagnosis and management of factitious SE are challenging. We report a new case of factitious SE with a very complex clinical course. A 29-year-old woman was seen at consultation for recurrent attacks of painful soft tissue swelling, affecting her chest wall, abdomen and neck over several months. Factitious disease was suspected because of the negative medical history of identifiable visceral perforations or gas-forming infections and the presence of multiple bizarre linear scars on the arm. This was supported by finding multiple recent puncture marks on the neck, chest and upper extremities on close inspection. The patient's history was remarkable for multiple stressful events in her life, frequent job changes, substance abuse and suicide attempts. Psychiatric evaluation revealed adjustment disorder with depression and anxiety, cluster B personality with bipolar II disorder and substance abuse. During the 1-year period, she had 20 visits to our ER for attacks of SE affecting various parts of her body. This case illustrates that self-infliction should be suspected in a patient presenting with medically unexplained recurrent SE and a hollow history, and one should search for puncture marks to support the diagnosis.

Pneumoparotitis with subcutaneous emphysema.

We report an adolescent with recurrent bilateral parotitis with pneumoparotitis and subcutaneous emphysema due to self pneumoinsufflation by a Valsalva like maneuver. Investigations for recurrent parotitis did not yield any clue. His la belle indifference, prolonged school absence and the presence of sibling rivalry helped us identify the psychological cause.

Factitious subcutaneous emphysema of an extremity.

The presence of air in the subcutaneous tissue of an extremity constitutes a fearful finding because of the potential devastating consequences for both the extremity and life of the patient. The authors present herein a rare case of self-induced subcutaneous emphysema of the thigh in a young patient, which resulted in aggressive management consisting of IV antibiotics, hyperbaric oxygen therapy, and surgical debridement. Correlation of the various findings of the history, physical examination, imaging and laboratory findings is critical in order to avoid unnecessary radical treatment. In the absence of an apparent cause, factitious disorder should always be considered.

Otolaryngological manifestations of factitious disorders--a case and literature review.

Otolaryngological manifestations of factitious disorders are rare. The case of a health care worker who injected her face and orbits with air in order to masquerade as facial cellulitis is presented. The literature and treatment strategies are reviewed.

Psychogenic vomiting complicated by marijuana abuse and spontaneous pneumomediastinum.

OBJECTIVE: This case illustrates an unusual physical sequel of psychogenic vomiting. CLINICAL PICTURE: A 22-year-old man with a picture of psychogenic vomiting and marijuana use developed the complications of a pneumomediastinum and subcutaneous emphysema. TREATMENT: Therapy included gradual exposure to anxiety provoking stimuli, psychotropics to reduce vomiting and psychotherapeutic exploration of family relationships. OUTCOME: The patient's vomiting and physical state resolved without complication. Follow-up at 12 months revealed continued improvement with occasional less severe vomiting. CONCLUSIONS: Psychogenic vomiting as a manifestation of anxiety can result in serious physical and psychological sequelae. This patient's desperate attempts to control such vomiting complicated the picture. Successful short term intervention included the use of several treatment modalities.

A unique case of Munchausen's syndrome.

A most unusual case of Munchausen's syndrome in an 18-year-old Yemeni female is described. The patient presented with bleeding from various sites; repeated subcutaneous emphysema of the face, orbit and upper chest; ulcers on the tongue, and dermatitis autogenica. The illness was confirmed to be factitious and self-induced when she was caught red-handed trying to inject air. We believe this to be the first report of a case where all these features occurred concurrently and only the second report where a patient developed self-induced orbital emphysema.