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Difficult diagnosis of factitious disorder
  1. Ali A Khalil,
  2. Julien Torbey,
  3. Leila Akoury-Dirani and
  4. Ramzi M Alameddine
  1. Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
  1. Correspondence to Dr Ramzi M Alameddine; ra169{at}


Factitious disorder imposed on another, or medical child abuse, has been rarely reported to have primary ocular presentations. We report an unusual and difficult diagnosis of factitious disorder imposed by a mother on her infant resulting in bilateral blindness. An infant was referred with a history of recurrent periorbital cellulitis and sanguineous discharge associated with seizure-like episodes. Symptoms have been going on for more than 14 months, and child had been treated by different physicians from different specialties without a clear ophthalmic diagnosis. The right eye was previously enucleated at an outside hospital for secondary complications of similar symptoms. He was admitted for exhaustive diagnostic tests and multiple surgical treatments, and his hospital stay was complicated with multiple corneal perforations and apnoeic episodes despite optimal treatment. After suspicion of factitious disease, continuous electroencephalography and video monitoring revealed evidence of the mother inflicting physical harm to her child.

  • Ophthalmology
  • Child abuse

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  • Contributors RA designed and directed the project. AK, JT and LA were involved in data collection. RA, AK, JT and LA were involved in the analysis and interpretation of results. RA, AK, JT and LA drafted the manuscript and designed the figures. All coauthors contributed to critically revising the manuscript and read and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.