Munchausen Syndrome (MS) has been widely recognized as a severe manifestation of factitious disorder, a condition where individuals intentionally fabricate or exaggerate symptoms for psychological gratification. It represents a complex diagnostic challenge due to its elusive nature and intricate relationship with various medical conditions. We present a clinical case of a 44-year-old woman observed in the context of Liaison Psychiatry, demonstrating the intricate interplay between chronic medical conditions, psychiatric factors, and the challenges in diagnosing and managing MS. The patient exhibited a history of recurrent hospitalizations, difficult-to-heal injuries, and a pronounced preference for surgical interventions. Despite diagnostic difficulties and poor therapeutic adherence, a multidisciplinary team approach involving plastic surgery, orthopedics, physical medicine, and rehabilitation, alongside Liaison Psychiatry, led to the diagnosis of MS with chronic osteomyelitis, ultimately necessitating a transtibial amputation. The case underscores the importance of early detection, a multidisciplinary approach, and the role of Liaison Psychiatry in managing MS. While early diagnosis may not alter the disease course, it can prevent unnecessary interventions and mitigate associated risks. The case also highlights the need for continuous psychiatric support and family involvement in addressing the recurrence of self-injurious behaviors. Further research is essential to enhance our understanding and develop effective treatment strategies for MS, contributing to improved diagnostic precision and overall management of this challenging psychiatric disorder.

We report a 31-year-old female presented with a history of recurrent skin and oral lesions for 10 years. She brought a histopathology report confirming the diagnosis of pemphigus vulgaris (PV), which was found to be faked with no patient information and lacked letterhead. Skin and oral examination only reveal multiple linear upper lip erosions. We believed the patient had a preliminary diagnosis of PV, and we asked the patient to continue her medications. Based on the conflicting history and occurrence of contradictory issues, a diagnosis of dermatitis artefacta was made. The patient improved after four sessions of dialectical therapy.

Intraoral soft tissue injuries occur due to physical, chemical, or thermal agents, which may present as ulcerations, burns, desquamation, and gingival recession. Camphor is one such substance easily available in many Indian households and is not a very well-recognized potentially fatal toxic compound. Here, we report the first case of an intraoral soft-tissue burn in a geriatric female, as a result of direct injury to tissues due to the application of crushed camphor powder to manage tooth pain at home, which was successfully treated with 2% Curcuma longa. Health care professionals must be aware of the presentation and extent of injury that can be caused by camphor when placed on intraoral soft tissues. Awareness among the public and professionals must be created in order to avoid any potential mortality. The diagnostician must consider the possibility of a chemical agent, such as camphor, as a potential source of the oral mucosal injury.

UNASSIGNED: Self-inflicted abdominal stab injury with an intention of self-harm is uncommon. Moreover, self-inflicted injury leading to avulsion of the colon has rarely been reported in the literature. We report a case of a 42-years-female with schizoaffective disorder who presented with self-inflicted stab injury on the abdomen resulting in abdominal evisceration.
METHODS: A 42-years-female with schizoaffective disorder (F25) for 10 years presented to the emergency department with multiple, self-inflicted injuries on the abdomen. A large free portion of the omentum and segment of the bowel were brought in a plastic carry bag. Examination revealed multiple transverse hesitation cuts in the epigastrium and a single deep penetrating transverse cut resulting in the evisceration of the omentum and colon. Intra-operatively, avulsion of a large portion of the greater omentum and missing segment of the mid transverse colon was observed. The patient underwent an immediate abdominal exploration and side-to-side colo-colic anastomosis along with diversion ileostomy. At three months following primary surgery, ileostomy closure was done.
CONCLUSIONS: Patients with schizophrenia spectrum psychosis are at risk of self-harm and in our case a schizoaffective patient presented with self-inflicted injuries that required an emergency abdominal exploration and repair. This case highlights a multi-disciplinary approach for the management of these cases and mandates clinicians and caregivers to be more vigilant to restrict injuries in the future.

This report describes a rare but life-threatening case of a suicide attempt initially considered as intentional overdose at the emergency department. Persistent altered mental status, despite normal toxicology investigations, led the attending team to order a head computed tomography scan, which revealed a bilateral penetrating nail gun injury with a right temporal hematoma for which a decompressive craniectomy was performed. Although voluntary intoxication is the most frequent form of suicide attempt, emergency physicians must be alert and maintain a broad differential diagnosis. Although rare, penetrating head injuries have increased in recent decades. As neurological symptoms can be minimal and penetration wounds small, this type of injury could potentially be overlooked.

Though foreign bodies of ear are quite commonly encountered in our day-to-day practice, self-inflicted penetrating injury of ear is not common. One such case of selfinflicted penetrating injury of ear with giant sized nail is presented here. In this patient the nail had traversed the whole thickness of skull and the pointed end of the nail could be traced at opposite temporal area. Extraction of the nail was posed with great difficulties as it was deeply impacted inside the dense bone of skull base. Miraculously, post-operative morbidity was very minimal in this case both in terms of intracranial tissue damage and hearing impairment.

Self-inflicted abdominal stab wounds are generally uncommon and there is no published report of survivors after extensive self inflicted disembowelment with mutilation. Here we present a case of 28 year old male who was brought to hospital 2 1/2 h after disembowelment through self inflicted abdominal stab injuries. The patient had hypovolemic shock due to bleeding from the mesentery and a 450 cm segment of small bowel which had been pulled out from 2 abdominal stab wounds and slashed multiple times by him. He had alcohol intoxication and hallucinations and did not seem to be in pain or emotionally affected by the severe injury. After resuscitation, and emergency resection with anastomosis he had an uneventful post-operative recovery. On psychiatric evaluation during follow-up, he was found to have schizophrenia aggravated by alcohol abuse and was treated accordingly. As self mutilation can be the first presentation of a psychotic episode, a psychiatric evaluation is necessary for all patients with self inflicted injuries.

OBJECTIVE: To report a case of an elderly patient with an unstable mental condition, presenting with the carcinoma of lip due to repeated toothpick injury.
BACKGROUND: Self-induced lesions of the face and mouth may be a manifestation of unusual or aggressive oral habits or an emotional disorder. The deliberate creation of orofacial lesions, is an indication of underlying psychiatric disease. Betel quid chewing is the major risk factor for oral cancer. It conditions the oral mucosa towards the development of cancer. Repeated trauma by self mutilation on such a conditioned mucosa can lead to the development of cancer.
METHODS: A male patient aged 85 years reported the complaint of a growth on the left side of the lower lip. Trauma followed by self inflicted injury had predisposed to the formation of cancer.
CONCLUSIONS: Diagnosis of self inflicted lesions are challenging as the histories of these lesions tend to be vague and misleading. Our knowledge in this particular pathology is limited mainly because of diagnostic difficulties and lack of solid statistical data.