SHM Converge Scientific Abstract ePoster Gallery-Keep Moving to Find a Diagnosis in a Patient Who Is Not Moving: Catatonia as a Presentation of Cervical Neuroendocrine Carcinoma

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This case describes a 34-year-old woman who presented with acute psychosis, paranoia, echolalia, psychomotor slowing, reduced oral intake, and catatonic features. She had no significant psychiatric or medical history and failed to improve with antipsychotics, mood stabilizers, or escalating lorazepam. Because of the atypical and refractory nature of her symptoms, clinicians broadened the evaluation beyond primary psychiatric disease.<br /><br />Initial workup, including labs, CT head, CSF studies, and infectious testing, was unrevealing. MRI brain showed nonspecific encephalitic changes. CT chest/abdomen/pelvis revealed right pelvic sidewall enlargement and lymphadenopathy, and MRI pelvis identified an exophytic cervical mass. The patient was treated empirically for suspected autoimmune encephalitis with IV methylprednisolone, IVIG, and rituximab, but she did not respond.<br /><br />Gynecologic oncology was consulted, and cervical biopsy confirmed stage IIIC2 cervical neuroendocrine carcinoma. CSF testing later returned positive for NMDA receptor antibodies, confirming paraneoplastic NMDAr encephalitis. She was started on chemotherapy and discharged for outpatient care. Two months later, her neuropsychiatric function had normalized.<br /><br />The report emphasizes that NMDAr encephalitis is an autoimmune disorder that can present with psychosis, seizures, and catatonia, and that about 38% of cases are paraneoplastic, most commonly linked to ovarian teratomas. This case highlights a rare association with cervical neuroendocrine carcinoma. It underscores the importance of considering autoimmune and paraneoplastic causes in adults with new-onset psychosis or catatonia, especially when symptoms are atypical or treatment-refractory. Early multidisciplinary evaluation is critical, as definitive improvement depends on treating the underlying malignancy.

Asset Subtitle

Suchi Agrawal

Meta Tag

Author List Divya Y. Popat, Joslyn Fisher, Meghana Nadella, Suchi Agrawal

Category Clinical Vignettes

Concept Anti-NMDA Receptor Encephalitis

Concept Autoimmune Encephalitis

Concept Psychosis

Concept Catatonia

Concept Paraneoplastic Syndrome

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Suchi Agrawal

Track Adult

Keywords

NMDAr encephalitis

paraneoplastic psychosis

catatonia

cervical neuroendocrine carcinoma

autoimmune encephalitis

new-onset psychosis

NMDA receptor antibodies

refractory psychiatric symptoms

gynecologic malignancy

multidisciplinary evaluation

Anti-NMDA Receptor Encephalitis

Autoimmune Encephalitis

Psychosis

Catatonia

Paraneoplastic Syndrome