Opisthotonic Posturing in a Neonate: A Clinical Masquerade of Sandifer Syndrome

Sapthami Sarala Sadananda, Sudha Rudrappa

Abstract

Sandifer syndrome is a benign disorder and rare complication of gastroesophageal reflux disease. Neonates present with crying, irritability, rumination syndrome, torticollis, dystonia, and mimicking epilepsy. The syndrome is characterized by spasmodic torsional dystonia and opisthotonic posturing. Other observations include ocular manifestation, delay in growth and development, irritability, and iron-deficiency anemia.

We present a case of a 25-day-old female neonate with opisthotonic posturing and a history of frequent regurgitation, cough, troubled feeding, and failure to gain weight. All the biochemical parameters were normal. Sandifer syndrome was suspected clinically, and the neonate was treated with a histamine-2 receptor antagonist. After the opisthotonic posturing reduced, she was started on a proton pump inhibitor (PPI) and was discharged with the PPI.

As the chances of misdiagnosing this case as infantile seizure are high, a thorough clinical evaluation was imperative to diagnose Sandifer syndrome.