Suspected Caregiver-Fabricated Illness Presenting as Osteomyelitis: A Case Report Illustrating the Diagnostic Challenges of Munchausen by Proxy: A Case Report and Review

Abstract

The term Munchausen syndrome by proxy (MBP) is not a formal diagnosis. As defined by the American Professional Society on the Abuse of Children (APSAC) consensus guidelines, MBP encompasses two distinct components: (1) the abuse of the child, variously termed medical child abuse, caregiver-fabricated illness in a child, abuse by paediatric condition falsification, or fabricated or induced illness; and (2) the psychopathology of the abuser, Factitious Disorder Imposed on Another (FDIA). The term MBP applies specifically when the abusive behaviour is committed by an individual with FDIA. Illness induction can also be committed by individuals who are malingering or who have other psychiatric conditions. We report a case of suspected MBP in which a 24-month-old male child presented with osteomyelitis in Kashmir, India. At least one prior case of other-induced osteomyelitis has been reported in the literature. The clinical investigation, including wound surveillance and CCTV monitoring, provided compelling evidence of caregiver-induced injury. The case is reviewed in the context of existing literature on MBP/FDIA, including the APSAC consensus guidelines. The cultural, social and institutional factors relevant to identifying and managing child abuse in the Kashmir region are discussed, and practical guidance for clinicians is provided. Caregiver-fabricated illness and MBP are rare. Healthcare professionals should be aware of its presentations and utilise established frameworks such as the APSAC guidelines for identification, assessment and management. Both the caregiver and the victim require intervention, and determining the underlying psychopathology is essential for long-term risk assessment and treatment planning.