Trapped in Silence: Severe Catatonia From Anti-N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis in a Neurofibromatosis Type 1 Patient With Craniopharyngioma

We report a challenging case of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in a 36-year-old female with neurofibromatosis type I (NF1) and a history of craniopharyngioma. Despite a functional ventriculoperitoneal (VP) shunt and negative infectious workup, she developed severe catatonia and neuropsychiatric symptoms, requiring intensive immunotherapy and psychiatric care. Diagnostic challenges arose from overlapping manifestations of neurofibromatosis I, recent central nervous system (CNS) procedures, and autoimmune encephalitis mimicking a psychiatric illness. Catatonia masked early treatment response, complicating clinical assessment. Her condition improved following coordinated multidisciplinary care, emphasizing the critical need for timely recognition and management of catatonia in autoimmune encephalitis, particularly in patients with neurogenetic disorders and recent neurosurgical history.