Recurrent Catatonia: Infection and Immunity in an Idiopathic Illness

Catatonia can be associated with multiple physical and mental illnesses, and idiopathic catatonia is a well-recognized clinical entity. Here we report a case of recurrent idiopathic catatonia with underlying immunologic abnormalities, with an emphasis on etiological hypotheses. An 18-year-old female with mild learning disability, dyspraxia, autoimmune hypothyroidism, and nonceliac gluten intolerance was referred to mental health services after developing an episode of catatonia following tonsillitis. She had experienced 2 previous episodes suggestive of catatonia, one of which developed after a snakebite and the other after a viral infection. Samples of cerebrospinal fluid and whole blood tested positive for human herpesvirus (HHV) on DNA-polymerase chain reaction testing during her third episode, but the patient had no signs of encephalitis. She responded well to lorazepam but developed significant side effects with low-dose olanzapine and aripiprazole. She returned to her usual baseline with medical management. Very little is known about possible etiologies of recurrent idiopathic catatonia. An atypical response to an HHV infection is a likely cause of one of the episodes in this case. There is substantial evidence connecting immune dysregulation to mental illnesses. Proinflammatory effects of latent HHV, proinflammatory genetic polymorphisms related to learning disability, and autoimmune dysfunction are likely factors that may have contributed to the development of recurrent catatonia following external antigen exposure in this case. Future research should focus on immune-mediated etiologies of catatonia, the role of immunotherapy in the treatment of idiopathic catatonia, and systems research to improve multidisciplinary management of neuropsychiatric disorders.