Catatonia in young: Distinguishing between neuropsychiatric systemic lupus erythematosus versus steroid and immunosuppressant-induced psychotic symptoms

Abstract: Catatonia is a neuropsychiatric phenomenon characterized by severe motor and behavioural abnormalities. It can arise as a complication when the central nervous system (CNS) is affected in patients with systemic lupus erythematosus (SLE). This case report describes a rare presentation of a 16-year-old female diagnosed with SLE, who developed catatonic features as her SLE symptoms worsened. Initially, she exhibited a depressive mood with emotional lability, followed by psychotic symptoms that progressed to mutism, posturing, echopraxia, and cognitive decline. Psychiatric management with olanzapine and amisulpride was ineffective. A lorazepam challenge provided transient improvement but did not lead to complete remission of catatonic symptoms. Ultimately, the addition of amantadine and lithium as adjuncts to lorazepam proved effective in managing catatonic state. The development of catatonia in the context of steroid and immunomodulator (e.g., cyclophosphamide) use exacerbated catatonic symptoms and contributed to the worsening of preexisting CNS lupus. This case highlights the potential emergence of catatonic features with the use of steroids and immunosuppressants-agents that are central to SLE treatment. Therefore, physicians should remain vigilant for motor disturbances, as their presence can worsen the prognosis and help differentiate catatonia from CNS lupus.