BACKGROUND
Factitious disorder, historically known as Munchausen’s syndrome, is a psychiatric condition characterized by the intentional fabrication or induction of symptoms without obvious external incentives. Patients frequently present with dramatic, medically convincing concerns that can mimic life-threatening illnesses and prompt extensive diagnostic evaluations. Although hemorrhagic presentations have been described, presentations mimicking catastrophic vascular disease are uncommon and pose unique challenges for emergency medicine and vascular teams.
CASE REPORT
A 37-year-old man with a subsequently documented diagnosis of factitious disorder repeatedly presented to multiple hospitals with dramatic hematemesis concerning for an aortoenteric fistula. Over an 8-year period, he underwent multiple diagnostic evaluations and several aortic interventions, including endovascular aortic repair and later explantation, despite repeated studies showing no aortoenteric pathology. In 2024, he developed bilateral renal artery occlusions secondary to focal aortic dissection requiring emergent stenting. A psychiatric evaluation at an outside institution ultimately diagnosed Munchausen syndrome. Recurrent presentations across healthcare systems, repeatedly negative diagnostic evaluations, inconsistent objective findings, and family-reported discovery of vials containing a red blood-like fluid provided additional evidence concerning for deliberate symptom fabrication.
CONCLUSIONS
This case report shows how factitious disorder can mimic life-threatening vascular disease. While urgent pathology must be excluded, recurrent high-acuity presentations accompanied by inconsistent objective findings should prompt cross-institutional record review, multidisciplinary evaluation, and broader diagnostic consideration to prevent unnecessary procedural escalation and iatrogenic harm, facilitate earlier diagnostic recognition, and support appropriate psychiatric intervention.

Keywords: Factitious Disorders; Aortic Diseases; Renal Artery