Halitosis Misattributed to Epilepsy and Psychosis: An Adolescent Case With Diagnostic and Cultural Complexity.

Abstract

Introduction: Persistent perception of an odor without objective confirmation has a broad differential diagnosis, including neurological, psychiatric, and other general medical conditions. Diagnostic complexity increases in the context of epilepsy, behavioral change and a distinct cultural setting. However, common reversible medical etiologies must remain central to evaluation.

Case presentation: We report an Indigenous (Inuit) adolescent with a 2 month history of perceiving a persistent "bad smell" originating from his mouth, accompanied by an unpleasant taste. These perceptions preceded his first generalized tonic-clonic seizure. Temporal lobe epilepsy was diagnosed, and the symptoms were initially attributed to epileptic auras. Despite seizure control, they persisted and were reinterpreted as first-episode psychosis, leading to psychiatric admission and antipsychotic treatment. However, lack of clinical improvement prompted multidisciplinary reassessment, revealing extensive dental pathology. Following comprehensive dental treatment, sensory, behavioral, and functional symptoms markedly improved, with complete recovery at 1-year follow-up.

Conclusion: This case highlights the importance of avoiding premature psychiatric attribution of physical symptoms through diagnostic humility, systematic reassessment, multidisciplinary collaboration, and culturally informed evaluation.