Munchausen syndrome by proxy presenting as recurrent burn-like lesions in two siblings

Factitious Disorder Imposed on Another (FDIA), previously termed Munchausen Syndrome by Proxy (MSBP), is a severe form of child abuse in which a caregiver fabricates or induces illness in a dependent child. Dermatological manifestations may mimic accidental injury, leading to delayed diagnosis. We report two female siblings aged 11 months and 3 years who presented with recurrent burn-like lesions over four months. The lesions involved atypical anatomical sites and appeared in multiple stages of healing. Histories provided by the caregiver were inconsistent with the clinical findings. Differential diagnoses, including accidental burns, phytophotodermatitis, bullous disorders, and caustic injuries, were considered. Lesions improved during supervised separation from the caregiver, raising suspicion of inflicted injury. During multidisciplinary evaluation, the elder sibling disclosed that a “grown-up” had applied a hot object to both children. Based on clinical findings and child-protection assessment, a diagnosis of FDIA was established.