Factitious disorders are quite common in diabetology and dermatology. They should be looked out for in patients with problematic hypoglycemia. We demonstrate a case of a pancreas transplantation candidate, in whom hypoglycemia and dermatitis factitia were found.
A 36 years old blind woman with a 6 years lasting type 1 diabetes was admitted for evaluation as an isolated pancreas transplantation candidate, due to a history of severe hypoglycemia refractory to insulin pump treatment.
Clarke hypoglycemia score was 5. The patient reported continuous glucose monitoring intolerance due to skin problems. Upon admission, multiple large superficial skin lesions on legs, abdomen, arms, neck and lower back were found, all reachable by patient hands. Previous dermatology and immunology assessments stated staphylococcus folliculitis or abscessing dermatitis. Wound specialist raised a suspicion on factitious etiology, supported by patient’s history of two psychiatric diagnoses. Moreover, pump download showed repeated cumulation of large boluses which the patient denied, total daily insulin dose was up to 79 units (1,3U/kg/day). After patient confrontation and maximum bolus setting adjustment, no further severe hypoglycemia occurred; during hospitalization, the patient was euglycemic on 0,5U/kg/day and tolerating continuous glucose sensors. Skin lesions were treated with an inert local dressing with silicone and covered with adhesive non-removable bandages to prevent manipulation or scratching. After a few days, signs of healing occurred.
In summary, device data download and mental health assessment should be a routine way of factitious disorders screening in transplant candidates, in whom healthcare professionals suspect self-harm.