Frontiers in psychiatry · 2026
Recurrent blood-spitting as a somatic presentation of pediatric functional neurological disorder: a case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Dh Tu, Nm Huong, Ln Anh, Na Vinh
Аннотация
BACKGROUND: Hemoptysis in children is typically associated with identifiable organic causes such as respiratory infection, bronchiectasis, or coagulopathy, and is often accompanied by respiratory symptoms or anemia. However, approximately 10-25% of pediatric cases remain cryptogenic or represent pseudohemoptysis despite extensive diagnostic evaluation.
CASE PRESENTATION: We report a 10-year-old boy presenting with daily recurrent blood-spitting manifested as scant blood-tinged saliva (<5 mL per episode) for 12 months. There were no accompanying respiratory or gastrointestinal symptoms, and no evidence of anemia. A comprehensive multidisciplinary evaluation including otolaryngology, pulmonology, gastroenterology (endoscopy), bronchoscopy, chest computed tomography, and video-electroencephalography revealed no organic source of bleeding. The episodes consistently co-occurred with psychogenic nonepileptic seizures during periods of psychosocial stress, including parental conflict and school-related anxiety.
DIAGNOSIS AND OUTCOME: The patient was diagnosed with functional neurological disorder (FND) according to the DSM-5-TR criteria. Recurrent blood-spitting was interpreted as a somatic symptom occurring within the clinical context of FND. A multidisciplinary treatment approach-including cognitive behavioral therapy, family therapy, pharmacological management, and caregiver psychoeducation-was associated with rapid clinical improvement. At 6-month follow-up, only rare stress-related recurrences were reported. Salivary cytology demonstrated scant erythrocytes without evidence of active bleeding.
CONCLUSION: This case highlights a possible clinical association between recurrent blood-spitting and functional neurological disorder in this clinical context. Early recognition of a functional etiology is essential to avoid unnecessary invasive investigations and to facilitate timely psychiatric intervention, leading to favorable clinical outcomes. Given the single-case design, causality cannot be established.
CASE PRESENTATION: We report a 10-year-old boy presenting with daily recurrent blood-spitting manifested as scant blood-tinged saliva (<5 mL per episode) for 12 months. There were no accompanying respiratory or gastrointestinal symptoms, and no evidence of anemia. A comprehensive multidisciplinary evaluation including otolaryngology, pulmonology, gastroenterology (endoscopy), bronchoscopy, chest computed tomography, and video-electroencephalography revealed no organic source of bleeding. The episodes consistently co-occurred with psychogenic nonepileptic seizures during periods of psychosocial stress, including parental conflict and school-related anxiety.
DIAGNOSIS AND OUTCOME: The patient was diagnosed with functional neurological disorder (FND) according to the DSM-5-TR criteria. Recurrent blood-spitting was interpreted as a somatic symptom occurring within the clinical context of FND. A multidisciplinary treatment approach-including cognitive behavioral therapy, family therapy, pharmacological management, and caregiver psychoeducation-was associated with rapid clinical improvement. At 6-month follow-up, only rare stress-related recurrences were reported. Salivary cytology demonstrated scant erythrocytes without evidence of active bleeding.
CONCLUSION: This case highlights a possible clinical association between recurrent blood-spitting and functional neurological disorder in this clinical context. Early recognition of a functional etiology is essential to avoid unnecessary invasive investigations and to facilitate timely psychiatric intervention, leading to favorable clinical outcomes. Given the single-case design, causality cannot be established.