Catatonia As Initial Presentation in Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis: A Case Report of a 19-Year-Old Patient

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis stands as the most prevalent form of autoimmune encephalitis, primarily affecting young patients and exhibiting a higher incidence among females. Patients frequently present with psychiatric symptoms or cognitive impairments such as speech disturbances, decreased level of consciousness, autonomic dysfunction, as well as seizures, dyskinesias, and catatonia due to overactivation of extrasynaptic NMDA receptors. To date, there is no gold standard for the diagnosis of catatonia; however, a few rating scales exist to measure this phenomenon, with the Bush Francis Catatonia Rating Scale being the most commonly used due to its validity, reliability, and ease of application. In this case, we present a 19-year-old female who experienced onset symptoms including fluctuating headaches, dysthymia, tinnitus, and prosopagnosia. Eventually, she experienced spatial disorientation and hypoesthesia in the left hemiface, along with insomnia. Subsequently, she reported alterations in perception, accompanied by urinary and fecal incontinence. Upon admission, the patient presented as catatonic. The lumbar puncture revealed normal cell counts, proteins, and glucose levels, along with the presence of reactive anti-NMDAR antibodies in serum and electroencephalogram findings indicating generalized dysfunction, meeting Graus criteria for probable encephalitis. A CT scan revealed a left adnexal mass consistent with an ovarian teratoma. Management commenced with methylprednisolone boluses and plasma exchanges. This case underlines the importance of ongoing research and collaboration in refining treatment strategies for autoimmune encephalitis patients to improve outcomes and quality of life.