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Dr. J. Boelaert, Algemeen Ziekenhuis St. Jan, Ruddershovelaan 10, B-8000 Brugge (Belgium) Dear Sir, Factitious illness represents a broad spectrum from simple malingering to Munchausen’s syndrome [1, 2]. Feigned hematuria and factitious feculent urine [2] have been reported, but we are not aware of reports of feigned myoglobinuria. Here we present such a case. Case Report A 45-year-old housewife complained of intermittent red discoloration of the urine. She had never had a medically related occupation, and had previously received psychological assistance for marital conflicts. During the preceding years she had been examined at two different hospitals. Urinalysis, performed 5 times, never disclosed more than 2 red blood cells/high power field, but the ortholi-dine dipstick was always positive. Proteinuria ranged between 2 and 4 g/l. Serum chemistry showed no evidence of either hemolysis or rhabdomyolysis. A muscle biopsy was reported as normal on optic and electron microscopy as well as on histochemical analysis. The patient came to us with the same complaint. Physical examination was normal. The urine was red with only 2 red blood cells/high power field. No pigmented casts were seen in the urinary sediment. The ortholidine dipstick test was positive. A dipstick for protein gave a very positive reaction and the 24-hour urine contained 2.9 g protein. Serum taken simultaneously had a normal color, the red blood cell and reticulocyte counts were normal and serum levels of haptoglobin, bilirubin and lactate dehydrogenase were normal. Serum levels of myoglobin (radioimmunoassay) and creatine kinase were also normal. Figure 1 shows the results of the cellulose acetate electrophoresis at pH 8.6 of the patient’s serum (fig. la) and urine (fig. lb). Serum electrophoresis is normal, while urine electrophoresis discloses 17% ß-globulin and 72% γ-globulin, consisting mainly of 2 bands. One of the fractions observed has an electrophoretic mobility similar to that of a commercially available (Sigma Chemical Co, St. Louis, Mo.) horse myoglobin standard (fig. lc), but different from that of hemoglobin (fig. Id) prepared by detergent lysis of human erythrocytes. Urine immunoelectrophoresis against polyvalent antihuman serum only showed very weak precipitation arcs for albumin and transferrin, whereas the bulk of the urinary m ¥1 I