Abstract
A 12 year old girl with previous history of Tourette syndrome and generalized anxiety disorder presented to an in-patient pediatric psychiatry unit with sudden onset repetitive cough for 3 weeks. An extensive medical work up did not reveal any medical explanation for her presentation. Two main diagnoses (tic cough and somatic cough syndrome (also known as psychogenic cough) were considered. The patient was followed for several weeks in the out-patient psychiatry clinic after discharge allowing the diagnostic formulation of her presentation to evolve. A mixed-approach intervention was implemented leading to significant improvement in her symptoms. The diagnostic quandary of medically unexplained cough in the presence of multiple confounding factors is examined.