313 Psychogenic Intractable Sneezing. Case Report

BACKGROUND: Sneezing is a coordinated protective respiratory reflex which occurs due to stimulation of the upper respiratory tract, and frequently accompanies allergic or nonallergic rhinitis. Sneezing can also arise due to bright light or sun (ACHOO syndrome), physical stimulants of the trigeminal nerve, psychogenic or central nervous system pathologies, sexual ideation and psychogenic sneezing. There are few case reports in the literature of patients with psychogenic sneezing. METHODS: 14-year-old girl who had incessant sneezing for over 4 days. The patient was initially seen in a rural hospital, were it was prescribed prednisone and antihistamines but the patient did not show any improvement. She was refered to 3rd level Hospital and treated with nasal steroids, antihistamines, and isotonic sodium chloride solution nasal spray; sneezing remitted in 2 hours. During a follow up visit nasal endoscopy was normal. Had a similar episode a month after that, and was referred to our service. She didn´t have either personal or family history of allergies. RESULTS: There were not abnormalities in physical examination but obesity; nasal cytology and skin tests to aeroallergens were negatives. Received the same management with isotonic sodium chloride solution nasal and the symptoms remitted. Consultation with psychiatry is requested by probable psychogenic sneezing. The interrogation relates to the loss of father 3 years also suffered from bullying for obesity. Combined treatment was initiated by psychiatry and psychology. CONCLUSIONS: Psychogenic Sneezing is a rare disorder, but should be considered in the differential diagnosis of sneezing. May have suspect if inspiratory phase is quite short and the amount of nasal mucosal secretion expelled very low. Eyes may remain open during sneezing. It usually develops due to psychogenic factors and is refractory to medical treatment. It is important to assess the patient in a holistic manner through a medical history and physical examination. Psychosocial environmental conditions should be investigated, and once identified the trigger requires a multidisciplinary treatment.