Attempted infanticide and suicide inaugurating catatonia associated with Hashimoto’s encephalopathy: a case report

Abstract

BackgroundCatatonia is a neuropsychiatric syndrome with motor and behavioural symptoms. Though usually occuring in patients with schizophrenia and mood disorders, this syndrome may also be associated with neurological diseases or general medical conditions. Few cases of catatonia associated with autoimmune disorders have been described.Case presentationHere, we report the case of a 27-year-old woman diagnosed with Hashimoto’s encephalitis (HE) who attempted suicide and infanticide by defenestration. As she presented risk factors for postpartum psychosis, she was treated principally with antipsychotics. Despite adequate treatment for psychosis, symptoms worsened and she developed catatonia. Complementary investigations showed elevated titres of anti-thyroglobulin and anti-thyroperoxidase antibodies (200 and 10 times, respectively, as compared to normal levels) and electroencephalography were suggestive of encephalopathy. In the presence of an otherwise unexplained neuropsychiatric condition, HE was suspected and oral prednisolone was introduced. Psychiatric symptoms improved dramatically within 72 h and the patient was still free of any symptom 3 years later.ConclusionCatatonia of organic aetiology should always be considered before a psychiatric aetiology especially in case of clinical worsening in spite of adequate psychotropic treatment. To our knowledge, this is the first description of catatonia associated with HE.

Psychiatric Presentations Heralding Hashimoto’s Encephalopathy: A Systematic Review and Analysis of Cases Reported in Literature

“…[16] The electroencephalographic findings showed a normal record in nine patients (19.6%) [17,19,20,23,35,37,46,47] while the most common abnormality noted was an intermittent or diffuse background slowing mostly in the frontal and temporal leads with or without bursts of sharp wave discharge (n = 25.54.3%). [12][13][14]16,18,20,24,[26][27][28][32][33][34]36,39,[41][42][43][44][45]49,50] Magnetic resonance imaging (MRI) returned normal study in 26 patients (56.5%). [14,15,16,17,20,21,[23][24][25][26][27][28]31,32,[36][37][38][39]…”

“…[12][13][14]16,18,20,24,[26][27][28][32][33][34]36,39,[41][42][43][44][45]49,50] Magnetic resonance imaging (MRI) returned normal study in 26 patients (56.5%). [14,15,16,17,20,21,[23][24][25][26][27][28]31,32,[36][37][38][39][41][42][43][44]46,48,50] Of the others whose imaging data were available, the single most common abnormality reported were nonspecific white matter hyperintense lesions (n = 9.19.6%). [12,13,19,32,…”

Hashimoto's encephalopathy in a pregnant female: A diagnosis in disguise

“…Because it lacks specific markers and is a clinically heterogeneous syndrome, HE remains an elusive nosologic entity. [5] Clinical manifestations include confusion, coma, stroke-like episodes, seizures, psychosis, dementia, myoclonus, and myelopathy. As in our case the pregnant female came with intractable hiccoughing which gradually progressed to stumbling and urinary incontinence along with the predominance of psychiatric symptoms and the presence of multiple risk factors, our initial diagnosis was psychosis.…”

Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis Presenting with Fever and Confusion

“…Since the first description of SREAT in 1966 [ 8 ], the clinical spectrum of the disease has expanded due to reporting of more cases with varying presentations. Majority of cases of SREAT run a fluctuating course with features such as cognitive impairment [ 9 ], seizures including status epilepticus [ 10 ] and myoclonus, tremor, ataxia, sleep disturbance, headache [ 11 ], depression, or psychosis [ 1 , 2 , 4 , 5 , 11 – 13 ]. Occurrence of focal neurological deficits has been described as well [ 8 , 14 ].…”