SHM Converge Scientific Abstract ePoster Gallery-The Silent Clue: Catatonia as a Sign of Hiv Infection

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This case describes a 32-year-old man with no known medical history who presented with altered mental status and fever, then progressed to mutism, fixed gaze, and minimal movement. Initial evaluation showed mild normocytic anemia, slightly elevated ammonia, and otherwise unrevealing labs, including normal B12, thiamine, RPR, TSH, BMP, hepatic panel, and negative CSF studies. MRI showed chronic brain atrophy and cerebral volume loss, and EEG demonstrated diffuse slowing.<br /><br />Psychiatry was consulted for suspected catatonia. Although he lacked classic findings such as rigidity or waxy flexibility, his poor responsiveness and improvement with an IV midazolam trial supported the diagnosis. The case highlights that catatonia is not a primary diagnosis but a syndrome caused by underlying medical, neurologic, psychiatric, toxic, or infectious conditions.<br /><br />HIV testing was considered because of the abnormal MRI and unexplained neuropsychiatric presentation, but it was initially delayed due to consent issues and uncertainty about the appropriate surrogate decision maker. After his mental status improved enough to consent, he tested positive for HIV with a very high viral load and CD4 count of 35. He later started antiretroviral therapy but developed Mycobacterium avium complex and immune reconstitution inflammatory syndrome (IRIS). Despite complications, he eventually improved and was discharged near his prior functional baseline after a two-month hospitalization.<br /><br />The key lesson is that HIV should remain on the differential diagnosis for catatonia, especially when standard workup is unrevealing. Prompt involvement of psychiatry, infectious disease, and ethics/consultative services may help overcome barriers to diagnosis and treatment.

Asset Subtitle

Yen Le

Meta Tag

Author List Katherine Oakden, Olivia Miller, Yen Le

Category Clinical Vignettes

Concept Catatonia

Concept Differential Diagnosis

Concept Human immunodeficiency virus infection

Concept Diagnostic Workup

Concept Altered Mental Status

Distinguished Non-Finalist

Presenter Organization University of Pennsylvania

Presenting Author Yen Le

Track Adult

Keywords

catatonia

altered mental status

HIV

Mycobacterium avium complex

immune reconstitution inflammatory syndrome

MRI brain atrophy

EEG diffuse slowing

mutism

midazolam trial

CD4 count 35

Catatonia

Differential Diagnosis

Human immunodeficiency virus infection

Diagnostic Workup

Altered Mental Status