A Gut Feeling: Acute Liver Failure – An Unusual Manifestation of Malignant Catatonia

Abstract

We present a rare case in which malignant catatonia led to acute liver failure (ALF). A 19-year-old male was admitted for psychosis and developed ALF with a peak aspartate aminotransferase and alanine aminotransferase of 5,728 U/L and 7,735 U/L, respectively, and a peak international normalized ratio of 7.1. Liver biopsy showed significant confluent necrosis involving >70% of the liver tissue. He was listed for a liver transplant but was ultimately taken off of because of significant improvement with treatment by Nacetylcysteine infusion. Through our research, we found that symptoms of hepatitis can be seen with psychotic disorders, but ALF is rare.

Evidence-based consensus guidelines for the management of catatonia: Recommendations from the British Association for Psychopharmacology

“…Malignant catatonia may be a rare cause of liver failure ( Kiparizoska et al, 2021 ). Catatonia has been reported secondary to Wilson’s disease ( Davis et al, 2021 ), after liver transplantation ( Chung et al, 2013 ; Cottencin et al, 2002 ; Huang et al, 2006 ; Kalivas and Bourgeois, 2009 ; Tatreau et al, 2018 ), including in post-transplantation delirium ( Brown et al, 2016 ; Kahn, 2016 ) as well as secondary to post-transplantation drug toxicities ( Davis and Tripathi, 2020 ).…”