When the Pain is Real but the Cause is Not: A Case of Leg Ulcer Pathomimia: Case Report

This case highlights a rare and under-recognized cause of chronic leg ulcers: pathomimia, a factitious disorder in which patients deliberately produce or simulate symptoms without external incentives. We report the case of a 33-year-old Moroccan woman presenting with a painless ulcer on the lower third of her left leg, alongside severe depression, insomnia, and persecutory delusions. Despite extensive investigations including MRI, skin biopsy, and microbiological tests, no organic etiology was identified. The diagnosis of pathomimia was supported by the patient's indifference to her lesion and the psychiatric context. Treatment included sertraline, alprazolam, chlorpromazine, and daily dermatological care, resulting in significant clinical improvement. This case emphasizes the importance of considering psychiatric causes in atypical or non-healing dermatological presentations. Early multidisciplinary intervention is crucial to ensure accurate diagnosis and effective management, avoiding unnecessary investigations and prolonged morbidity.