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Malignant catatonia due to anti-NMDA-receptor encephalitis in a 15-year-old girl: case report and summary of current knowledge

Author(s): Stefania Aulicka, Ondrej Horak, Lenka Mrazova, Petr Mikolasek, Jaroslav Sterba, Lenka Krbkova and Hana Oslejskova

Anti-N-methyl-D-aspartate receptor encephalitis is a recently identified autoimmune disorder with a prominent neuropsychiatric presentation. We present the case of a 15-yearold girl with partial complex seizures with secondary generalization and acute mania with psychotic features. A positive diagnosis of anti-NMDA-receptor encephalitis suggested the specific treatment. Despite first-line immune treatment, the patient progressed to stupor, malignant catatonia, and autonomic instability with the risk of cardiopulmonary function failure. She improved after second-line immunosuppressive therapy (cyclophosphamide and rituximab simultaneously). Post-cognitive sequelae (memory impairment and deliberation) disappeared within 8 months of follow-up treatment and intensive cognitive rehabilitation. This case report emphasizes the importance of differential diagnosis and adequate treatment of catatonic syndrome, especially in young adults. Early recognition and adequate treatment is essential for a good outcome for the patients.

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