Munchausen syndrome in an adolescent child presenting with unexplained rash

Munchausen syndrome is a rare and difficult to diagnose psychiatric condition that falls within the spectrum of factitious disorders. Patients engage in various behaviours with the conscious intention of producing symptoms, dramatizing existing symptoms, and maintaining medical attention. Dermatological symptoms are among the most commonly observed physical manifestations of this syndrome and often complicate differential diagnosis. Here, a 16-year-old female adolescent presented with a one-week history of progressively spreading, ill-defined, macular, eroded, and crusted lesions. A detailed clinical evaluation revealed no systemic findings or pathological laboratory abnormalities except for leukocytosis and mild anaemia. Autoimmune, infectious, and allergic causes were thoroughly ruled out. The patient’s history included a dramatic course, attacks associated with food intake but not clinically confirmed, and frequent visits to different healthcare centres. During hospitalisation, the lesions increased and decreased daily; systemic and local treatments provided limited and temporary relief. During the change of the patient’s intravenous line, the arm was wiped with alcohol and pigment transferred to the cotton. Inconsistencies in the patient’s history a diagnosis of Munchausen syndrome was made. This case highlights the importance of considering artificial disorders in the differential diagnosis of unexplained, treatment-resistant, and atypically distributed skin lesions, particularly during adolescence. Delayed diagnosis can lead to unnecessary tests and treatments and even iatrogenic harm, so these cases should be carefully managed with a multidisciplinary approach.