[Catatonic syndrome caused by autoimmune disease: spontaneous remission]

The psychiatric manifestations of systemic lupus erythematosus and other autoimmune diseases, which may precede by many years systemic involvement, should be held in mind by both the internist and psychiatrist. This case report focuses on a female catatonic patient without metabolic disturbances, whose evolution did not suggest a schizophrenic disorder. Immune complexes were demonstrated to be present in cerebrospinal fluid (CSF) obtained during psychotic crisis and immunologic tests showed circulating immune complexes with a positive antinuclear factor. (1/800) and a nucleolar pattern with immunofluorescence. The psychiatric picture receded concomitantly with a fall in CSF immune complexes and with an increase in circulating immune complexes, without the administration of immunosuppressive drugs. The catatonic syndrome is a rare manifestation in patients with autoimmune disease and few cases have been reported without systemic manifestation. This report emphasizes the need for increased awareness of the psychiatric effects brought about by autoimmune diseases and shows that CSF immune complexes are valuable markers for their diagnosis.