Perturbação Factícia Bolhosa Simulando Penfigoide Bolhoso: Relato de Caso e Revisão da Literatura

Factitious disorder in dermatology is a dermatosis occuring with increasing frequency all over the world. Prevalence is reported around 2% in dermatology clinics but it is probably underdiagnosed, since the patient is not usually aware of its self-inflicted nature. When manifested by bullous lesions, it can be confused with autoimmune bullae. We report the case of a 59-year-old patient accompanied by psychiatry for severe depression with psychotic symptoms, dissociative amnesia, Munchausen syndrome and fibromyalgia who developed tense blisters on the dorsum of her left foot. The findings of the first histopathological examination suggested bullous pemphigoid and treatment with prednisone was performed. Due to the persistence and fixed location of the lesions, psychiatric history and negative direct immunofluorescence, a new histopathological examination was performed and interpreted as a case of bullous factitious disorder.