SIMULATION: Question of Quincke’s disease.
Case 471. (Lewitus, May, 1915.)
An infantryman was brought to the eye department of the Wieden Hospital early in May, 1915, with a diagnosis (from the internists) of Quincke’s disease.
Under the conjunctiva of each globus oculi were countless small air vesicles. There was not the slightest emphysema of the eyelids or of the skin about the eyes. The skin in the neighborhood of the zygoma was thick, red and swollen; but no air could be demonstrated in the subcutaneous tissues on palpation. Next day the skin swelling and the conjunctival emphysema had disappeared. No communication of the orbits with the air spaces of the skull could be demonstrated nor was it possible to push air into the conjunctiva by nose-blowing. The fundi were both normal and vision was normal. Special rhinological examination showed the nose to be normal. It was the skin swelling of the orbital region that had given rise to the diagnosis of Quincke’s disease. The man had been then referred to the internists who could, however, find no evidence of disease whatever.
During the three months’ stay of the patient in the eye department, once more swelling of the left orbital region and air under the conjunctiva of the left globus oculi suddenly appeared one day, but disappeared over night. At this time small subconjunctival ecchymoses were found.
This case must be regarded as one of simulation but produced in a manner unknown.