The first case of Richard Asher syndrome (Munchausen syndrome) in Iraq

Abstract

Background: Richard Asher syndrome was first described by Richard Asher in 1951, and he named it “Munchausen syndrome” after a fictionalized German character, Baron von Munchausen who was traveling and telling fantastic tales about his invented deeds. Richard Asher syndrome has not been reported from Iraq before. Patients and methods: The case of a patient complaining of recurrent bleeding per rectum over the previous seven years is described. Results: A male who was otherwise health was seen at about the age of 30 years because he was complaining of recurrent bleeding per rectum of about seven years. He didn’t have bleeding from another site or any systemic symptom. He said that the last episode of bleeding occurred before about one week. All of the previous investigations including ESR complete blood count, stool examinations, abdominal ultrasound, abdominal X-ray, barium enema radiography and lower endoscopy showed normal findings. He said, previously a doctor diagnosed his illness as ulcerative colitis and prescribed him oral sulfasalazine to be taken during the episodes of bleeding, and another doctor suggested surgical removal of the colon. As it was not possible to identify any pathology, he was advised to wait for the next episode, and to do stool examination on the day of bleeding. However, after few weeks he came again and said that the last episode of bleeding occurred before about one week, and he didn’t do stool examination during the days of bleeding. Conclusion: As early as 1955, Tyndel rightly criticized naming the syndrome after Baron Munchausen, as this name is not representative of the syndrome, and considered to be misleading because Baron Munchausen was considered as a source of harmful fantastic humor. Therefore, the appropriate name is Richard Asher syndrome. The first case of Richard Asher syndrome from Iraq is reported in this paper.