The problem with Munchousen is two fold. One, if it was Munchousen Justina should be getting better. She is not.
The second is that her older sister has the same disorder and appears to be doing ok under the Tuffs prescribed treatment.
I did hear from an MD that a diagnosis of mitochondria disease can indeed be a marker for hypochondria or Meunchausen's. But, even so, the deterioration of the patient is an alarm bell.
And the refusal to allow pictures to be taken? That's an indication of something to hide...