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To the Editor.
—We read the recent article by Feinsilver et al1 with interest. There are a few points we would like to make.First, hemoptysis is one of the commonest manifestations of Munchausen's syndrome, leading Asher,2 who gave the classic description, to remind us of the colloquialism "haemoptysis merchants." This leads us to suggest that the syndrome should be included in the differential diagnosis of abnormal bleeding during the initial phase of case history-taking, rather than merely considering the possibility later on when physical investigation findings have proved negative.Second, pulmonary Munchausen's syndrome3 with multiple chest surgery, as distinct from the commoner "laparotomaphilia migrans,"2 is a recognized problem, further illustrating the need to bear the syndrome in mind when dealing with diagnostic difficulties of "thoracic" origin.Third, Feinsilver et al use the criteria of Ireland et al4 for the identification of Munchausen cases. One
O'Shea B, Falvey J, Cahill M, McGennis A. Factitious Hemoptysis. Arch Intern Med. 1984;144(2):415-419. doi:10.1001/archinte.1984.00350140249043