Sir.—The report by Paperny et al (Journal 1980;134:794-795) described a teenage girl who was hospitalized 23 times for numerous medical problems, including recurrent septic arthritis. These episodes eventually were found to be self-induced and she was categorized as having Munchausen syndrome. A recent clinicopathologic exercise1 described a 40-year-old woman with Munchausen syndrome manifested by intermittent polymicrobial bacteremia and fever due to self-injection of bacteriologically contaminated material. The intentional injection of contaminated material into others or oneself is recognized in adults1-3; however, the extent of this abhorrent behavior in children is unknown. In younger pediatric patients, due to the age and lack of necessary medical knowledge, inoculation of contaminated material is not self-inflicted, but represents a bizarre form of child abuse.
Report of a Case.—A child, 4 years 8 months old, was hospitalized on numerous occasions for recurrent, severe infections complicated by a concurrent, secondary immune deficiency