Approach to diagnosis of factitious disorder with unexplained hemoptysis: A case report

Rationale:Hemoptysis or hematemesis is a common clinical symptom in adults, but is unusually to be observed in children. Hemoptysis can occur with circulatory diseases, injuries, several types of systemic diseases, or systemic factors including factitious disorder (FD), which is difficult to be diagnosed. Here, we report a case of hemoptysis caused by FD to provide a diagnostic flow chart for such kind of disease.Patient concerns:An 11-year-old female patient had a history of hemoptysis or hematemesis for 6 months and suffered with paroxysmal syncope for a month.Diagnosis and intervention:A series of examinations had been launched to evaluate any possible malformation or abnormalities of the patient including fiberoptic bronchoscopy, cardiac catheterization, gastroscopy, nasolaryngoscopy, electrocardiogram, electroencephalogram, and enhanced magnetic resonance image of the paranasal sinus. Several methods had been performed and tried to stop hemoptysis such as taking hemostatic medications, lavage of fiberoptic bronchoscopy, and embolism for abnormal bronchial arterial using cardiac catheter. All the interventions, however, failed to achieve our treatment goal. Given that more careful observation during hospitalization had been done, and we suspected the symptom of hemoptysis from this patient might be originated from an FD.Outcomes:Based on the diagnosis of FD, targeted psychological intervention was provided by experts. After the treatment completed, the patient did not present hemoptysis anymore.Lessons:FD is an uncommon type of disease. This rare case described here is to help us to reconsider the long diagnosis process of hemoptysis with a series of examinations including some invasive procedures, whether all the examinations and interventions are necessary for a nonsevere hemoptysis patient.