Case Report: Rapid resolution of psychogenic cough in an adolescent following bromazepam treatment

Somatic cough syndrome, formerly termed psychogenic cough or habit cough, is an under-recognized cause of chronic cough in pediatric populations, characterized by repetitive, dry, and honking cough that is absent during sleep. Behavioral interventions are first-line treatment with high success rates of 80%-90%. However, when access to behavioral therapy is unavailable, alternative pharmacological interventions, particularly benzodiazepines, have received minimal investigation in this population.

I report a 13-year-old previously healthy male patient with abrupt-onset, near-continuous dry cough occurring every 2 seconds during waking hours. The cough had a distinctive honking quality and disappeared completely during sleep. The patient presented with severe impairment in function, including inability to eat for 3 days, multiple emergency presentations requiring intravenous hydration, and complete school absence. Medical evaluation, including physical examination, laboratory investigations, spirometry, and chest X-ray, was unremarkable. Empirical trials of inhaled bronchodilators and nasal corticosteroids yielded no improvement. Psychiatric assessment excluded psychotic features, depression, obsessive-compulsive disorder, and tic disorder but noted family stressors, including high expressed emotion and overprotective parenting behavior. Based on the sign of sleep-related cough cessation and exclusion of organic pathology, somatic cough syndrome was diagnosed. Given the severity of impairment and family circumstances precluding immediate behavioral therapy, bromazepam 3 mg orally was initiated. Within 24-36 hours, the cough resolved completely. At 3-month follow-up, the patient remained symptom-free without medication. He had returned to school and demonstrated normal eating patterns.

This case demonstrates rapid and sustained resolution at 3-month follow-up of severe psychogenic cough following short-term bromazepam treatment in an adolescent. While behavioral therapy is still an evidence-based first-line treatment, this report suggests using benzodiazepines as a pharmacological intervention alternative when behavioral therapy is unavailable. The rapid response and sustained remission at 3-month follow-up are consistent with the hypothesis that benzodiazepines may interrupt the self-perpetuating cycle of anxiety and cough in somatic cough syndrome. Further research is needed for this case in pediatric populations to establish efficacy, safety, and optimal treatment duration.