A case of intractable sneezing: 'a pleasure sent from God?'

Sneezing or sternutation is usually the physiologic response to nasal irritation. The reflex follows a very complicated pathway requiring coordinated communication between the trigeminal and nervous terminalis afferent impulses as well as from glottic and inspiratory muscles in the efferent limb. When the reflex pathway is unbalanced, sneezing can increase in frequency and severity to the extent that some patients become disabled. We present the clinical examination, differential diagnosis, and treatment modalities for the case of an adolescent male who experienced debilitating intractable sneezing for more than one year. As for many of the patients described with this elusive diagnosis, our patient appears to have a functional etiology.