We present a case in which electronic records were appropriated to create factitious reports.

In 1995, a 32-year-old man sought experimental therapy for metastatic adenocarcinoma of the urinary bladder. He reported a history of adenocarcinoma of the bladder that had recurred despite irradiation, chemotherapy plus autologous bone marrow transplantation, and investigational chemotherapy. The patient brought copies of his records, including diagnostic surgical pathology and cytology reports and several radiology reports. The physical examination was normal.

We contacted the pathologist at the hospital where most of the patient's care was reported to have been given. She discovered discrepancies in the photocopy of the surgical pathology report that suggested tampering. The pathology department's file contained no records for the patient; the accession numbers on the report corresponded to those of reports for other patients. Two reports of a primary invasive adenocarcinoma of the urinary bladder and metastasis to the spine were found to be composites of diagnostic reports for other patients. Final diagnoses and the pathologist's signature had been appropriated from these records. The replicated handwritten signature, which crossed over typed lines, indicated that portions of reports, including the printed institutional logo and format, had been electronically scanned, recombined, edited, printed, and copied.

The patient maintained that these discrepancies were a product of a disorganized medical record system and that because he lacked health insurance, he had conspired with a social worker to be registered under an alias name and social security number. He would not reveal this name and number for fear of compromising the social worker. Despite compelling assurances that he would provide us with the requested documentation, the patient was lost to follow-up.

Seven patients feigning cancer have been described in the English-language literature [1-5]. Patients have submitted to surgery, irradiation, and cytotoxic chemotherapy. Like other patients with Munchausen syndrome, those who have feigned cancer tend to be refractory to psychiatric treatment.

We believe that the factitious reports in our case were created by electronically scanning and modifying reports belonging to others. How the patient obtained other patients' reports is unclear; discarded draft copies of reports are possible sources. The medical community should be aware of potential for privacy violations as computerization of the medical records becomes more widespread.