Probable Autoimmune Encephalitis Presenting With Catatonia in a Young Woman: A Case Report and Review of the Literature.

Abstract

ObjectiveTo present a case of probable autoimmune encephalitis initially misdiagnosed as a primary psychiatric disorder.MethodA case of probable autoimmune encephalitis presenting with catatonia in a young woman 6 months post-partum is described in this article.ResultsThe patient was admitted to an outside hospital, diagnosed with a primary psychiatric condition, and sent to psychiatric inpatient, where she was denied admission due to labile hypertension. After admission to the medical service (and ICU), she responded to a lorazepam challenge, and made a complete recovery within several weeks after combination treatment with IV methylprednisolone, IV immunoglobulin (IVIG), and rituximab.ConclusionAutoimmune encephalitis should be suspected in patients presenting with labile vital signs, family history of autoimmunity, and new psychosis without prior history of psychiatric problems. Other important diagnostic considerations include neuroleptic malignant syndrome, substance-induced psychosis, or catatonia secondary to post-infectious immune-mediated encephalitis. While a first psychotic break should always be considered, the presence of autonomic instability, catatonia, seizures, or dyskinesias in a young woman postpartum should prompt a thorough medical and neurological work-up.