A Case of Catatonia Later Diagnosed with NMDA Receptor Encephalitis

Saejeong Lee; Myong-Wuk Chon; Jungsun Lee; Chang-Yoon Kim

doi:10.16946/kjsr.2017.20.1.23

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Lee, Chon, Lee, and Kim: A Case of Catatonia Later Diagnosed with NMDA Receptor Encephalitis

Case Report

Korean Journal of Schizophrenia Research 2017; 20(1): 23-27.

Published online: 30 April 2017

DOI: https://doi.org/10.16946/kjsr.2017.20.1.23

A Case of Catatonia Later Diagnosed with NMDA Receptor Encephalitis

Saejeong Lee, MD¹, Myong-Wuk Chon, MD, MS², Jungsun Lee, MD, PhD², Chang-Yoon Kim, MD, PhD²

¹Department of Psychiatry, Daejeon Hankook Hospital, Daejeon, Korea.

²Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Chang-Yoon Kim, Department of Psychiatry, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: 02-3010-3410, Fax: 02-485-8381, cykim@amc.seoul.kr

Received 25 March 2017 Revised 24 June 2017 Accepted 26 June 2017

Abstract

We report a case of a young female patient with catatonic features who later turned out to be suffering from an anti-NMDA (N-methyl-D-aspartate)-receptor-antibody encephalitis. A previously healthy 21-year-old woman was admitted to psychiatric inpatient care presenting with acute psychotic behavior with catatonic features. Laboratory tests of serum and CSF (Cerebrospinal fluid), EEG (Electroencephalogram), brain MRI (Magnetic Resonance Imaging) were unremarkable except vague slow wave on EEG. However, subtle cognitive impairment at the bedside examination suggested further imaging studies to rule out possible organic etiology like autoimmune encephalitis. Brain PET (Positron Emission Tomography) and SPECT (Single Photon Emission Computed Tomography) suggested probable inflammation in the brain. In case of autoimmune encephalitis, given the severity of symptoms and worsening course, steroid pulse therapy was initiated promptly even though the diagnosis was not confirmed but presumed at that time. She recovered completely with steroid therapy. Later her disease turned out to be anti-NMDA-receptor-antibody encephalitis by the antibody test which was not available at the time of admission. Psychiatrists need to be aware of autoimmune encephalitis like anti-NMDA-receptor-antibody encephalitis in the differential diagnosis of acute psychosis with catatonic features. Subtle cognitive impairment which tends to be overlooked due to catatonic features might be a clue to suspect the organic etiology.

Keywords: Catatonia, Cognitive impairment, Anti-NMDA-receptor-antibody encephalitis

Figures and Tables

Fig. 1

Bedside examination on hospital day 8. The patient showed perseveration in clock drawing and tracing task.

Fig. 2

SPECT image on hospital day 9. Mildly decreased perfusion of right frontal & temporal cortex.

Fig. 3

PET image on hospital day 9. Hypermetabolic signal on right temporo-parietal cortex.

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