A Scottish man who pinched his nose to stifle a sneeze while driving has become the first reported case of spontaneous tracheal perforation from sneezing, doctors report.

The University of Dundee–led team says the case serves as a reminder of the potentially catastrophic consequences of holding in one’s sneeze given the rapid build-up of pressure involved.

“Normally, the pressure in the upper airways during sneezing is 1-2kPa; however, if the mouth and nose are closed, the pressure may increase by up to 20 times,” they wrote in BMJ Case Reports.

Their patient, in his 30s, had a background of allergic rhinitis.