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Factitious Hemoptysis-Reply

Steven H. Feinsilver, MD; Thomas A. Raffin, MD
Arch Intern Med. 1984;144(2):419. doi:10.1001/archinte.1984.00350140249044.
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In Reply.  —We thank O'Shea et al for their interesting comments and additional insights into factitious illness. It is good to know there are physicians interested in learning more about the psychotherapy of Munchausen's syndrome.When O'Shea and his colleagues suggest that Munchausen's syndrome should be part of the initial differential diagnosis in patients with hemoptysis, we find it difficult to generate a great deal of enthusiasm. This is especially so in patients with massive hemoptysis such as the one described. Munchausen's syndrome is extremely uncommon and the practicing physician should consider common causes first and then progress to zebras if answers are not forthcoming. Of course, any clues emanating from a complete history and physical and laboratory examination that raise the specter of factitious illness should quickly point the physician in that direction.We are glad that O'Shea et al agreed to some extent ("not entirely agree") that nonwandering


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