A Unique Presentation of Excitatory Catatonia Alongside AntiNmda Receptor Encephalitis: A Case Report

Authors

  • Abbagoni Sujith Medical College of Georgia at Augusta University, USA  Author
  • Revorado Stephanie Medical College of Georgia at Augusta University, USA Author
  • Panda Sambit Medical College of Georgia at Augusta University, USA Author
  • Venkatesh Sreeram Assistant Clinical Professor of Psychiatry and Health Behavior at Medical College of Georgia at Augusta University, USA Author
  • Athanasiadi Argyro Director of Consultation and Liaison Psychiatry Department, Clinical Assistant Professor of Psychiatry and Health Behavior at Medical College of Georgia at Augusta University, USA Author

DOI:

https://doi.org/10.47363/JNPR/2024(2)107

Keywords:

Anti-NMDAR, Encephalitis, Catatonia, Autoimmune

Abstract

Introduction: Anti-NMDA receptor encephalitis, first described in 2007, is a prominent cause of autoimmune encephalitis, predominantly affecting
females. Its clinical presentation includes a prodromal phase with flu-like symptoms, followed by psychosis, unresponsiveness, hyperkinesis, and recovery [1]. Catatonia can coexist sounds better than cooccur in patients with anti-NMDA receptor encephalitis, complicating diagnosis and effective treatment.
Case Summary: This case report discusses a 41-year-old African American female with a history of seizure disorder, schizoaffective disorder with catatonia, developmental delay, Catatonia in itself is not the diagnosis as per dsm 5. We could use it as a specifier with other diagnosis, be it schizoaffective disorder or seizure disorder here. So we could mention as schizoaffective disorder with catatonia. and recent bereavement. Her symptoms included variable motor hyperactivity, alternating between restlessness and sedation, with an initial Busch Francis Rating Scale score of 18. Initially diagnosed with excitatory catatonia secondary to schizoaffective disorder and treated with benzodiazepines, her condition failed to improve, prompting further investigation. Despite additional treatment for a urinary tract infection and medication adjustment, which included adding valproic acid and amantadine, her condition remained
uncontrolled. Subsequent lumbar puncture revealed inflammatory markers, and her anti-NMDA receptor IgG antibody assay was positive at 1:1280, confirming the diagnosis of anti-NMDA receptor encephalitis. Treatment was escalated to include methylprednisolone and intravenous immunoglobulin, alongside six sessions of ECT for management of her catatonia. The patient showed significant improvement, achieving functional recovery and independence in daily activities before discharge.
Conclusion: This case emphasizes the importance of considering anti-NMDA receptor encephalitis in patients with unexplained, refractory neuropsychiatric symptoms, such as catatonia, and highlights the value of a multidisciplinary approach in managing and rehabilitating affected individuals. Prompt diagnosis and treatment are crucial to improving outcomes and reducing the risk of persistent cognitive deficits.

Author Biographies

  • Abbagoni Sujith, Medical College of Georgia at Augusta University, USA 

    Abbagoni Sujith, Medical College of Georgia at Augusta University, USA 

  • Revorado Stephanie, Medical College of Georgia at Augusta University, USA


    Medical College of Georgia at Augusta University, USA

  • Panda Sambit, Medical College of Georgia at Augusta University, USA

    Medical College of Georgia at Augusta University, USA

  • Venkatesh Sreeram, Assistant Clinical Professor of Psychiatry and Health Behavior at Medical College of Georgia at Augusta University, USA

    Assistant Clinical Professor of Psychiatry and Health Behavior at Medical College of Georgia at Augusta University, USA

  • Athanasiadi Argyro, Director of Consultation and Liaison Psychiatry Department, Clinical Assistant Professor of Psychiatry and Health Behavior at Medical College of Georgia at Augusta University, USA

    Director of Consultation and Liaison Psychiatry Department, Clinical Assistant Professor of Psychiatry and Health Behavior at Medical College of Georgia at
    Augusta University, USA

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Published

2024-08-20

Issue

Vol. 2 No. 1 (2024): Volume 2, Issue 1

Section

Articles