Functional Neurological Disorder Presenting as Psychogenic Non-epileptic Seizures Associated With Recurrent Hemoptysis: A Diagnostic Challenge

Abstract

Functional neurological disorder (FND), previously termed conversion disorder, is characterized by neurological symptoms that are incongruent with recognized neurological or medical conditions. Psychogenic non-epileptic seizures (PNES) are among its most common manifestations; however, hemoptysis occurring in association with PNES is exceedingly rare. A 15-year-old male presented with recurrent seizure-like episodes of one-year duration that progressively increased in frequency. During episodes, he remained conscious, responsive, and able to communicate, with no post-ictal confusion, urinary incontinence, or tongue biting. The events were accompanied by recurrent hemoptysis, chest pain, and hyperhidrosis. Extensive investigations, including hematological and biochemical testing, electroencephalography, magnetic resonance imaging of the brain, autoimmune encephalitis panel, upper gastrointestinal endoscopy, computed tomography of the chest, bronchoscopy, and otorhinolaryngological evaluation, failed to identify an organic etiology. Following multidisciplinary assessment by neurology and psychiatry teams, a diagnosis of FND presenting as PNES with associated hemoptysis was established. The patient was managed with psychotherapy, psychiatric support, selective serotonin reuptake inhibitors (SSRIs), and clonazepam, with tranexamic acid administered during episodes of hemoptysis, resulting in symptomatic improvement. This case highlights an unusual presentation of FND and emphasizes the importance of comprehensive multidisciplinary evaluation in patients with PNES and unexplained hemoptysis. Recognition of this rare association may prevent unnecessary investigations, facilitate timely diagnosis, and enable appropriate psychological and supportive management.