A 29‐year‐old white woman with a stated a history of stage 1 breast cancer was admitted for pancytopenia secondary to cyclophosphamide. The pancytopenia was discovered when a complete blood count (CBC) was drawn prior to dental work for a tooth abscess. At admission, CBC values were: white blood cell count 0.1, hemoglobin 6.4, hematocrit 17.9, and platelets 2. The patient was admitted to the intensive care unit (ICU) under neutropenic precautions, her cyclophosphamide was held, and she was transfused packed red blood cells for anemia and given G‐CSF. A hematologist/oncologist was also consulted, as the patient's stated specialist did not have privileges at our institution. In an attempt to get records from her outside specialist, the patient gave several names of treating physicians and contradictory information regarding her care. All the physicians the patient named denied having her as a patient. When confronted with this information, the patient admitted to not having breast cancer. She diagnosed herself with breast cancer based on a family history of breast cancer and filling out an online questionnaire designed to assess risk factors for breast cancer. After filling out the questionnaire, the patient ordered cyclophosphamide from a Web site in India. Further investigation found that the patient had previous admissions for multiple diagnoses with extensive workups each time, including multiple laparoscopies, MRI, MRA, MRV, and lumbar puncture. After the patient's pancytopenia resolved, she was transferred out of the ICU to a medical floor. Psychiatry was consulted and admitted the patient for evaluation and treatment. On the night after being admitted to psychiatry, the patient was sent to the emergency department for self‐reported hematuria. Urinalysis did not reveal any abnormalities, and the patient was returned to psychiatry.
No previous cases of malingering have been reported in which a patient became pancytopenic because of chemotherapy for self‐diagnosed breast cancer. The literature revealed a similar case in which a patient had bilateral mastectomies for self‐reported breast cancer, the reason in that case being retaliation for a perceived lack of attention as a child. Our patient's case was unique because of her self‐diagnosis being made using an online breast cancer risk factor calculator and the ease by which she was able to obtain cyclophosphamide. Even after admitting the cause of her condition, the patient continued to fabricate medical issues, such as the reported hematuria the night of admission to psychiatry.
The purpose of reporting this case is to bring awareness to hospitalists of the ease by which patients can obtain information and medications on the Internet for medical conditions and how information and medications can be incorrectly utilized to induce life‐threatening medical problems in themselves.
M. Satyanarayan ‐ South Dayton Acute Care Consultants, employee; M. Saiyasombat ‐ Kettering Medical Center, resident.
To cite this abstract:Satyanarayan M, Saiyasombat M. Case Report: Factitious Breast Cancer with Pancytopenia Secondary to Cyclophosphamide. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 385. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/case-report-factitious-breast-cancer-with-pancytopenia-secondary-to-cyclophosphamide/. Accessed April 8, 2020.