This study reports a rare case of high-dose
midazolam abuse and
Munchausen Syndrome. A 48-year-old female physician was referred by a psychiatrist to the Toxicology Department of Imam Reza Hospital for abstaining from 300 mg/day of parenteral
midazolam. She had mimicked the symptoms of
Crohn's disease; therefore, she had undergone 15 colonoscopies and 40 times MRI or CT scan, all of which were normal. Six months earlier, she had switched oral
methadone to 30 mg/day of intravenous
midazolam. She also had several skin lesions on injection sites that she considered
pyoderma gangrenosum. When the total daily dose of intravenous
midazolam was switched to oral bioequivalence of
clonazepam, she could not tolerate withdrawal (Clinical Institute Withdrawal Assessment Scale-Benzodiazepines = 68). Therefore, she received
midazolam again as a continuous
intravenous infusion. Within 7 days, the whole dose was replaced by the bioequivalence oral dose of
clonazepam. She was also treated with
carbamazepine and cognitive behavior therapy. Afterward, she was transferred to the psychiatric ward for further psychiatric treatment. Dependency on a high dose of
midazolam could be treated by tapering off the long-acting
benzodiazepine.