SHM Converge Scientific Abstract ePoster Gallery-Catatonia in Systemic Lupus Erythematosus: A Multifaceted Clinical Presentation

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This case describes a 40-year-old woman with a history of major depressive disorder and bipolar disorder with psychotic features who presented with disorganized thinking, withdrawal, depressed mood, echolalia, negativism, and poor oral intake. She was diagnosed with severe depression with catatonic features and initially treated with IV lorazepam, but her catatonia improved only minimally.<br /><br />Because she also had bilateral hand and wrist pain along with thrombocytopenia and leukopenia, a rheumatologic evaluation was performed. Testing showed a very high ANA titer (1:2560), positive anti-dsDNA, anti-Smith, and ribonucleoprotein antibodies, and low complement levels (C3 and C4). Brain MRI, total spine MRI, and CSF studies were unrevealing, helping rule out other neurologic causes such as neuromyelitis optica or multiple sclerosis. Based on these findings, she met SLICC criteria for systemic lupus erythematosus (SLE).<br /><br />She was treated with high-dose steroids and cyclophosphamide for neuropsychiatric SLE, with moderate improvement. Her catatonia also required ongoing IV lorazepam and later amantadine. With combined psychiatric and rheumatologic treatment, she improved enough to be discharged with follow-up in both specialties. She is now near her physical and mental baseline and remains on maintenance therapy, with a plan to consider tapering psychiatric medications six months after hospitalization.<br /><br />The report emphasizes that neuropsychiatric manifestations occur in about 50% of SLE patients, but catatonia is rare and can be difficult to recognize because its symptoms overlap with psychiatric and medical disorders. Clinicians should maintain a broad differential and consider autoimmune disease when evaluating acute catatonia.

Asset Subtitle

Eleanor E. Bate

Meta Tag

Author List Eleanor E. Bate, Pahresah Roomiany

Category Clinical Vignettes

Concept Catatonia

Concept Systemic Lupus Erythematosus

Concept Echolalia

Concept Negativism

Concept 2012 SLICC Criteria

Distinguished Non-Finalist

Presenter Organization Duke University Hospital System

Presenting Author Eleanor E. Bate

Track Adult

Keywords

systemic lupus erythematosus

neuropsychiatric SLE

catatonia

major depressive disorder

bipolar disorder

anti-dsDNA

anti-Smith antibodies

low complement

lorazepam

cyclophosphamide

Catatonia

Systemic Lupus Erythematosus

Echolalia

Negativism

2012 SLICC Criteria