Diagnostic Dilemma – Hashimoto’s Encephalopathy in Treatment-resistant Schizophrenia

Abstract Hashimoto’s encephalopathy is a rare neuropsychiatric entity characterized by pleomorphic presentations. Although classically described as a corticosteroid responsive autoimmune encephalopathy, the treatment itself may complicate symptoms in an already diagnosed case of schizophrenia. Here, we report the case of a 31-year-old male, diagnosed case of treatment-resistant schizophrenia, who was incidentally diagnosed with autoimmune encephalitis during routine blood work up. The diagnosis was confirmed with an endocrinologist as well a neurologist. The patient showed aggravation of symptoms on steroid, hence was given thyroxine only. He was started on clozapine but due to minimal improvement was augmented with thrice a week electroconvulsive therapy. The patient showed improvement in symptoms and is regularly following up on outpatient basis. Our case illustrates the diagnostic dilemma regularly faced by psychiatrists while treating cases of treatment resistance and the need to unravel autoimmune etiologies for designing effective treatment modalities.