An alternative approach to diagnosis and treatment of intractable paroxysmal sneezing in a child.

Background: Intractable paroxysmal sneezing is a rare and diagnostically challenging condition in children, often mimicking organic diseases. While it is often addressed as psychogenic in the literature, our case presented findings suggestive of a tic disorder, highlighting the need for a broader diagnostic perspective.

Case presentation: An 11-year-old girl was referred to the child and adolescent psychiatry clinic with a one-year history of persistent and fluctuating sneezing episodes. Despite comprehensive evaluations by pediatric neurology, allergy, and otolaryngology services, no significant pathology was identified. While the symptoms initially appeared psychogenic due to their onset following a school change and exacerbation during periods of heightened stress, a detailed assessment revealed findings suggestive of a tic disorder, including the fluctuating nature of the symptoms, their absence during sleep, and transient suppressibility. Partial symptomatic relief observed with metoclopramide, a dopamine antagonist, led to the initiation of risperidone therapy (0.25-0.5 mg/day), which resulted in significant clinical improvement.

Conclusions: This case illustrates the complex interplay between psychogenic stressors and tic-like manifestations in pediatric intractable paroxysmal sneezing. The positive response to risperidone underscores the potential role of dopamine antagonist treatments in managing such cases. A multidisciplinary approach is crucial for accurate diagnosis and effective management, ultimately enhancing patient quality of life.