Factitious fever (FF) is one of the possible presentations of chronic factitious illness. Factitious fever is further categorized as one of the possible causes of fever of unknown origin (FUO). FF can be caused by a range of psychiatric and non-existing illnesses, namely Munchausen syndrome, Munchausen syndrome by proxy, malingering, and various personality disorders. The patients with FF may present with atypical symptoms of a certain disease and may appear to be genuinely ill. They may deliberately falsify their history and tamper with physical findings to achieve this. This may be done for a number of reasons, such as in order to gain attention from health professionals. Individuals with FF may also change their hospital or caregivers frequently.

Of note, FF occurs more commonly among individuals with a medical background such as medical students, nurses, pharmacists, and laboratory technicians. One proposed explanation is that it is easier for them to gain access to medical supplies, as well as to garner attention from their colleagues.

There are a number of ways in which FF can be created and these include manipulation of thermometers to show a higher reading, infecting oneself using various contaminants, and taking drugs that raise body temperature [1] [2]. Self-induced infection may additionally result in recurrent episodes of skin and soft tissue infections such as cellulitis and abscesses or bacteremia that is poly-microbial. The isolated organisms could include Streptococcus viridans, Pseudomonas aeruginosa, and microbes found in fecal matter.

Other clues of FF are reported fever with no other systemic signs such as tachycardia or skin that is unusually warm to touch. FF may be a difficult diagnosis to make as FUO is in itself a challenge to clinicians [3]. FF is, however, one of the most prominent causes of FUO [4].

• Fever

  Factitious fever (FF) is one of the possible presentations of chronic factitious illness. Factitious fever is further categorized as one of the possible causes of fever of unknown origin (FUO). [symptoma.com]

  A retrospective study identified 2.2 per cent (11 of 506) of all patients whose fever on their charts was coded as fever of undetermined origin as having factitious fever. [ncbi.nlm.nih.gov]

  factitious fever Fever produced artificially by a patient. [medical-dictionary.thefreedictionary.com]

  • To be able to have a plan to approach a patient with Fever when the basic clinical and laboratory tests did not reveal much as to the cause of fever Fever of unknown origin (FUO) :is a sustained, unexplained fever despite a comprehensive diagnostic [studyslide.com]

• Malingering

  Factitious fever (FF) is a false disease that can be secondary to psychiatric illness or malingering. It constitutes one of the differential diagnoses of fever of unknown origin (FUO). [symptoma.com]

  Malingering is not a psychiatric diagnosis, and may be easier to identify than factitious disorder as the motivation for feigning illness in malingering is usually much more clear. [clinicaladvisor.com]

  ‘Researchers also note the need to examine the patient's psychological status when hysteria, malingering, or factitious illness may be a factor.’ [en.oxforddictionaries.com]

  See: factitious disorder ; malinger ; Munchausen syndrome [medical-dictionary.thefreedictionary.com]

• Hyperthermia

  MacNeal WJ: Hyperthermia, genuine and spurious, Arch. Int. Med. 64: 800, 1939. CrossrefGoogle Scholar 2. HaleEvseichick VO: Fraudulent fever, Am. J. Nursing 43: 992, 1943. Google Scholar 3. [acpjournals.org]

  Heat production exceeding heat loss is the second mechanism that leads to fever, with examples including salicylate poisoning and malignant hyperthermia. [clinicalgate.com]

  Cited by Habitual Hyperthermia: An Interpretive Paradigm of the 20th Century? Not Really. Ginier-Gillet M, Esparcieux A. Ginier-Gillet M, et al. Int J Gen Med. 2021 May 25;14:2063-2068. doi: 10.2147/IJGM.S306423. eCollection 2021. [pubmed.ncbi.nlm.nih.gov]

  Hyperthermia- A. Fever- elevated hypothalamic set point B. Hyperthermia- normal set point, but failed peripheral regulatory mechanisms V. Peripheral Heat disorders- body is exposed to heat or cold but can’t adequately compensate. [premedicaluniversity.com]

  Low grade fever can occur with habitual hyperthermia, chronic fatigue syndrome, or fibromyalgia. [sharinginhealth.ca]

• Disability

  Please enable JS and disable any ad blocker [ouest-france.fr]

  Deliberate disability. Br Med J. 1956; 1: 361 Scopus (32) PubMed Crossref Google Scholar Mawson SR Munchausen's syndrome (Correspondence). Lancet. 1956; 1: 107 Scopus (1) Abstract Google Scholar Bunim JJ Federman DD Black RL et al. [amjmed.com]

  Further, the public health impact of factitious disorders can be significant, as patients with factitious illness utilize healthcare resources unnecessarily and often have associated disability. [clinicaladvisor.com]

• Infectious Mononucleosis

  Possible investigations may include: FBC: raised white cell count in infection, inflammatory conditions and malignancy; tests for infectious mononucleosis. [patient.info]

  The distribution of the rash (eg, extremities [Rocky Mountain spotted fever], trunk [eg, infectious mononucleosis, typhoid fever], or palms and soles [eg, syphilis]), the chronicity of the rash relative to fever, and the character of the rash (eg, vesicular [ime.acponline.org]

  mononucleosis, HIV, Hepatitis A, B and C) • Bacterial (chlamydial infection, Q fever, brucellosis, mycoplasma infection, syphilis, leptospirosis, Lyme disease, Yersinia infection, streptococcal infection) • Fungal(Cryptococcus antigen, histoplasmosis [studyslide.com]

  Other symptoms of infectious mononucleosis vary with age with middle aged adults and the elderly more likely to have a longer duration of fever and leukopenia, and younger adults and adolescents more likely to have splenomegaly, pharyngitis and lymphadenopathy [en.wikipedia.org]

  HIV infection infectious mononucleosis lower respiratory tract infection malaria osteomyelitis Rocky Mountain spotted fever strep infection (streptococcus infection) systemic viral syndrome tonsillophyaryngitis or tonsillitis tuberculosis tularemia urinary [healthofchildren.com]

• Dermatitis

  Davis Company ET - 24 DB - Taber's Online DP - Unbound Medicine ER - FACSM fact sheet fact witness factitial dermatitis factitious factitious diarrhea factitious disorder factitious fever factor factor H factor V Leiden mutation factor VII deficiency [tabers.com]

  Factitious dermatitis is a condition of psychopathological basis using the skin as a means of expression, being the person unable to verbalize their internal unrest. [context.reverso.net]

  JAMA. 1957; 165: 927 Scopus (61) PubMed Crossref Google Scholar Lyell A Dermatitis artefacts in relation to the syndrome of contrived disease. [amjmed.com]

  Inflammatory: phlebitis, thyroiditis, ulcerative colitis, Crohn's disease, pancreatitis, familial Mediterranean fever, sarcoidosis, pemphigus, severe or exfoliative dermatitis, bullous pemphigoid. [patient.info]

  Also, one patient had history of dermatitis artefacta and another had history of Henoch - Schonlein purpura. No patient came for even a single follow-up. The socio-demographic and clinical details of the cases are presented in [Table 2]. [ijpm.info]

• Flushing

  As the body temperature drops the person becomes warm and flushed due to vasodilation and diaphoresis sets in to assists with heat loss. If the pyrogens are not removed, a new set point will be set and the body temperature will continue to rise. [sharinginhealth.ca]

  Rest is recommended and large quantities of clear liquids to flush out toxins and help prevent dehydration. Some practitioners recommend letting a fever run its course or cooling the body with cool sponge baths. [healthofchildren.com]

• Delayed Wound Healing

  It is usually an atypical presentation of a common disease (Wolff et al., 1975; Adison et al., 1978; Keefer and Leard … Factitious disorder--fever and delayed wound healing K Fritzsche, N Venhoff, A Larisch - Deutsche Medizinische …, 2008 - europepmc.org [scholar.google.it]

• Self-Mutilation

  Also found in: Dictionary, Thesaurus, Legal, Encyclopedia. factitious fever A fever of unknown origin described in either young female health professionals, which occurs after a legitimate disease, or in older neurotic female who are prone to self-mutilation [medical-dictionary.thefreedictionary.com]

  CRABTREE J: A psychotherapeutic encounter with a self-mutilating patient. Psychiatry 30:91-100, 1967 CrossrefGoogle Scholar 78. ADLER G: Hospital treatment of borderline patients. Am J Psychiatry 130:32-36, 1973 CrossrefMedlineGoogle Scholar 79. [acpjournals.org]

• Denial

  However, as no clear structured methods are available to diagnose the FD and no clear guidelines are available to confront, precautionary methods need to be taken to avoid untoward outcomes like absconding and denial for follow-up. [ijpm.info]

• Hematuria

  Factitious hematuria and self-induced Candida albicans fungemia. Gordon GH, Chrys R. Gordon GH, et al. West J Med. 1985 Aug;143(2):246-9. West J Med. 1985. PMID: 4036123 Free PMC article. No abstract available. Publication types MeSH terms [pubmed.ncbi.nlm.nih.gov]

  Renal cell carcinoma or hypernephroma may present with intermittent fever in up to 15% of patients.[1,33] Flank pain, microscopic hematuria or erythrocytosis (due to increased production of erythropoietin) may suggest the disease. [medscape.com]

  Patients may also falsify objective signs by tampering with equipment or laboratory specimens, such as by manipulating a thermometer to produce evidence of a fever, or by adding blood to a urine sample to simulate hematuria. [clinicaladvisor.com]

  […] every medical condition known, the prevalence of the disorder is particularly high in a few select groups, including patients who present with persistent rashes and nonhealing wounds, unexplained anemia, neurologic problems, endocrine-related problems, hematuria [emedicine.medscape.com]

• Confusion

  Hot dry skin, tachycardia, high temperature and confusion. This pt. needs mechanical lowering of their body temp and administration of fluid and salts. D. [premedicaluniversity.com]

  Antipyretics (eg, paracetamol and ibuprofen) should therefore not be used routinely but can be of value, especially for patients with systemic disease (particularly heart failure or respiratory failure) and when fever causes acute confusion. [patient.info]

  The person may appear confused, make absurd statements, and report hallucinations (the experience of sensing things that are not there; for example, hearing voices). [clevelandclinic.org]

  In practice, however, many still use this term interchangeably with factitious disorder, and this confusion is reflected in the case literature. [emedicine.medscape.com]

Factitious fever should be approached with possible comorbidities and complications in mind. Possible complications of self-induced infection include bacterial endocarditis and septic pulmonary emboli. Psychiatric evaluation of the patient should also be carried out in the presence or absence of psychiatric symptoms, especially in chronic or repeated illness.

A thorough history and physical examination are instrumental in excluding possible causes of the fever [5] [6]. Routine laboratory tests such as complete blood count (CBC), inflammatory markers, metabolic panel, urinalysis, and blood and urine cultures should be carried out. In addition, various imaging modalities, such as chest X-rays and ultrasound, may also be carried out at the clinician's discretion. Computed tomography (CT) and magnetic resonance imaging (MRI) scans may be incorporated as the next step in the investigation.

• Candida

  Factitious hematuria and self-induced Candida albicans fungemia. Gordon GH, Chrys R. Gordon GH, et al. West J Med. 1985 Aug;143(2):246-9. West J Med. 1985. PMID: 4036123 Free PMC article. No abstract available. Publication types MeSH terms [pubmed.ncbi.nlm.nih.gov]

No clearly effective treatments Treatment of factitious disorder imposed on self is usually challenging, and there are no clearly effective treatments. [msdmanuals.com]

The primary treatment for Factitious Disorder is psychotherapy (a type of counseling). Treatment likely will focus on changing the thinking and behavior of the individual with the disorder (cognitive-behavioral therapy). [clevelandclinic.org]

[…] resulting either from the production of illness or from the performance of unnecessary tests or treatments If the patient is receptive to psychiatric treatment, patient education may be an important component of psychotherapy. [emedicine.medscape.com]

The non-punitive confrontation, which reformulates the disorder as a request for help, promotes patient adherence to psychiatric treatment. 8 Treatment of Munchausen's syndrome should focus on the underlying motivations. [elsevier.es]

Treatment Most children who undergo evaluation for FUO do not receive treatment until a clear-cut cause is found. [healthofchildren.com]

Exceptions: empiric steroids for suspected GCA or empiric abx in neutropenic patients Prognosis Depends on age and etiology of FUO (worse with elderly and malignancy as etiology) Most without Dx after extensive evaluation have good prognosis with low [utswim.wordpress.com]

These patients generally have a good prognosis, with resolution of fever in several months. [ime.acponline.org]

Prognosis- The patient's prognosis is dependent on the underlying disease process and by how soon a diagnosis is obtained. Outcomes are worse for neoplasms. [atsu.edu]

Prognosis The more chronic and severe Munchausen variant of factitious disorder appears to follow an unremitting course, and the prognosis is generally poor. [emedicine.medscape.com]

Therapy is adjusted after a diagnosis is made.[3] Prognosis[edit] Since there is a wide range of conditions associated with FUO, prognosis depends on the particular cause.[1] If after 6 to 12 months no diagnosis is found, the chances diminish of ever [en.wikipedia.org]

Abstract The problem of elucidating the etiology of fever is one of the most fascinating and challenging that confronts the physician. [annals.org]

The authors define an unexplained fever as a fever which lasts a minimum of 14 days and whose etiology is not known. [books.google.com]

Etiology Five groups of etiology are commonly used in FUO publications: infections, cancers, noninfectious inflammatory diseases, miscellaneous causes and undiagnosed causes. [medscape.com]

Epidemiology Classic FUO etiologies fall into 5 major categories: Infection, Malignancy, Inflammatory, Miscellaneous, Unknown Distribution depends on decade, patient age, geography, and type of practice Etiology Infections Tuberculosis (extrapulmonary [utswim.wordpress.com]

Sweeping updates include new or revised chapters on: Hepatitis C and antivirals Fungal infection and newer antifungals Microbiome and infectious diseases as well as advances in diagnosis of infection; Clostridium difficile epidemiology; infection control [books.google.com]

Epidemiology Classic FUO etiologies fall into 5 major categories: Infection, Malignancy, Inflammatory, Miscellaneous, Unknown Distribution depends on decade, patient age, geography, and type of practice Etiology Infections Tuberculosis (extrapulmonary [utswim.wordpress.com]

RF, ANA, other inflammatory antibodies serology, according to local epidemiology HIV tuberculosis CMV EBV biopsy (liver, bone marrow) Diagnostic Imaging Imaging should initially include: chest X ray abdominal and pelvic ultrasound Other modalities could [sharinginhealth.ca]

International statistics Whether the epidemiology of factitious disorder differs in countries other than the United States is unclear. [emedicine.medscape.com]

[…] has also been a case report on concurrent presence of FD and FD by proxy. [5] Another newer concept or problem in this field is "Munchausen by Internet," where a person may post false stories of his illness on internet forums to gain attention. [6] Epidemiology [ijpm.info]

This book covers pathophysiology of fever, the general approach to the febrile patient, and offers a systematic, in-depth discussion regarding the differential diagnosis of unexplained fever. [books.google.com]

[…] labeled immunoglobulins, and 18-fluoro-deoxy-glucose. return to top Management If no causes are identified after work-up, a number of options are possible: watchful waiting inflammation tracer scintigraphy staged approach therapeutic trials return to top Pathophysiology [sharinginhealth.ca]

Pathophysiology The pathophysiology of factitious disorder has not been determined. No causative brain defect or dysfunction has been identified. A study of 5 cases suggested neurocognitive deficits. [emedicine.medscape.com]

The tenth issue in our growing online database, edited by James Newman, covers essential updates in the following topics: Long QT; Noninvasive ventilation; Fever of Unknown Origin; Post Bariatric Surgery; Hospital Fall Prevention; Mimics of Cellulitis [books.google.de]

Prevention Although FUO cannot actually be prevented because the sources are unknown, the immune system can be strengthened to help avoid infection from bacteria, viruses, and toxins. [healthofchildren.com]

It is also important to drink enough liquids, to prevent dehydration. Familial Mediterranean fever (Medical Encyclopedia) Fever (Medical Encyclopedia) When your baby or infant has a fever (Medical Encyclopedia) [ Read More ] [icdlist.com]

Better understanding and identification of these children is likely to help prevent the development of more chronic adult factitious disorders. factitious disorder Munchausen by proxy children adolescents factitious illness Received January 19, 1999. [pediatrics.aappublications.org]

Can Factitious Disorder be prevented? There is no known way to prevent Factitious Disorder. However, it may be helpful to start treatment in people as soon as they begin to have symptoms. References: American Psychiatric Association. [clevelandclinic.org]

1. Aduan RP, Fauci AS, Dale DC, Herzberg JH, Wolff SM. Factitious and self- induced infection; a report of 32 cases and review of literature. Ann Intern Med. 1979;90:230–242.
2. Gershwin ME, Gude JK, Petralil J. Factitious Subcutaneous Emphysema. Ann Intern Med. 1971;75:585–587.
3. Petersdorf RG. Fever of unknown origin. An old friend revisited. Arch Intern Med. 1992;152(1):21-22.
4. Barbado FJ, Vázquez JJ, Peña JM, Arnalich F, Ortiz-Vázquez J. Pyrexia of unknown origin: changing spectrum of diseases in two consecutive series. Postgrad Med J. 1992;68(805):884-887.
5. Hayakawa K, Ramasamy B, Chandrasekar PH. Fever of unknown origin: an evidence-based review. Am J Med Sci. 2012;344(4):307-316.
6. Sipahi OR, Senol S, Arsu G, et al. Pooled analysis of 857 published adult fever of unknown origin cases in Turkey between 1990–2006. Med Sci Monit. 2007;13(7):CR318-322.