What is it about?
The patient presented with psychiatric symptoms and no other somatic issues eight days after COVID 19 positiv PCR test. MRI was normal and the laboratory work-up was nearly normal. The standard autoimmune encephalitis tests (Euroimmun) were also normal. FDG PET showed high uptake in striatum. In the figure, you can see the autonomic deregulation that developed which included desaturations and blood pressure fluctuations. We stained mouse brain tissue which revealed a clear immunoreactivity against a target in the striatum, perhaps targeting spiny neurons? We demonstrate a reduction in autoantibodies in CSF after plasmapheresis.
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Why is it important?
We think this case is extremely important because it could easily been missed and gone untreated. We are now just starting to recognise malignant catatonia as potential autoimmune encephalitis but historically these cases have not received immunotherapy and developed chronic conditions. We do not recognise the staining pattern and suggest that this could be a novel form of limbic encephalitis.
Perspectives
We have since identified other cases with debut of psychosis or catatonia after COVID. Sometime the infection is so mild, the symptoms weeks before the psychiatric symptom would not have been noticed if we were not in a pandemic situation where the population is vigilant and viral testing is available. This data has made us much more aware of the possible significance of infections with mild symptom presentations.
Janet L Cunningham
Uppsala Universitet
Read the Original
This page is a summary of: Autoimmune Encephalitis Presenting With Malignant Catatonia in a 40-Year-Old Male Patient With COVID-19, American Journal of Psychiatry, June 2021, American Psychiatric Association,
DOI: 10.1176/appi.ajp.2020.20081236.
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