Factitious disorder Quiz: Ace Your Exams

A 17-year-old girl presents to the emergency department to evaluate an ongoing autoimmune disease. The patient’s mother reports, “We just came to this hospital from out of state; we left because those uneducated doctors could not figure out what is going on with my daughter. She has been ill since birth with several autoimmune diseases but has been more ill over the past several weeks.” The patient reports ongoing fatigue over the past several weeks. The mother has a past medical history of lupus, common variable immune deficiency, and diabetes. When the nurse comes into the room for IV placement, the mother requests a central venous catheter be placed because “Most nurses have difficulty placing an intravenous line in my daughter.” Vital signs are within normal limits. Physical examination reveals a very thin female in no acute distress with multiple track marks noted on the upper extremities bilaterally. A hospital band from another hospital is noted on the patient's right wrist. She demonstrates a sad and withdrawn affect. She has no hallucinations or delusions. The patient does not have suicidal or homicidal ideation. The patient's lab work, including a complete blood count, comprehensive metabolic panel, electrocardiogram, and urinalysis, is within normal limits. Which of the following is the most likely diagnosis?