Sneezing – A symptom of respiratory or psychogenic superposition of illness in a teenager?

Abstract

Introduction. The coincidental combination of allergic respiratory diseases and psychogenic or psychiatric illness is possible but rarely associated in a female teenager. Case report. A girl aged 12.5 years was admitted to the Pediatrics Clinic in the Clinical Centre Kragujevac with the main difficulty of sneezing as 10 sneezes in each of the 500–600 series a day, only in the waking state. Working diagnoses were tic disorders associated with Allergic rhinitis, asthma and biochemically determined rickets. The patient was treated with chlorpromazine, desloratadine, montelukast, fluticasone propionate, vitamin D, azelastine hydrochloride along with the elimination diet. After a year and a half, the patient rarely sneezed, but periods without sneezing were not longer than 3 months, and she ‘cleared her throat’ occasionally. Although her clinical condition is less severe now and without additional motor tics or symptoms of Tourette's disorder, because of its length we suspect the tic turned into a chronic vocal tic disorder. Conclusion. We reported a case of rare association between allergic rhinitis and condition of tic-related conversion in a female teenager and emphasized the necessity of revising the systematisation for the tic disorders and protocol for the allergic rhinitis in terms of their association.