Recurrent blood-spitting as a somatic presentation of pediatric functional neurological disorder: a case report

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.