Recurrent renal colic in young people: abdominal Munchausen syndrome--a diagnosis not to forget.

The Munchausen's syndrome (MHS) is a rare psychiatric disorder classified among the self-manipulated diseases. Incidence of Munchausen syndrome peaks in young-to-middle-aged adults, but it has been reported in patients of all ages (ie, childhood through advanced age). Diagnosing Munchausen syndrome is very difficult, but early diagnosis could to a considerable extent prevent the iatrogenic risks. Indeed, the management of Müchhausen syndrome is aggravated by the low compliance in these patients. We report an unusual case of MHS in urological practice, in order to demonstrate that the MHS is an underestimated and laborious to diagnose syndrome. A 25-year-old single female affected by recurrent episodes of renal colic was admitted to our institution, reporting right acute flank pain and at least two previous periods of hospitalization due to bilateral acute flank pain with no evidence of urinary calculi or either morphological or functional alterations. Neither the urodynamic study nor abdominal CT scan nor pelvic NMR revealed any morphological or functional alterations. In order to exclude a multiple sclerosis, an encephalic NMR and neurological evaluation were also performed. At this stage, suspicion was raised regarding the possible factitious nature of her problem and a psychiatric consultation was made. On the basis of psychiatric consultation and the symptoms resolution with simple intravenous saline solution infusions, the diagnosis of factitious illness (Munchausen syndrome) was confirmed. In the present case report, we stress the fact that the MHS is an underestimated medical problem and the necessity to evaluate the possible role of psychiatric disorders in the absence of pathological findings.