Catatonia and Cotard's Syndrome in a Patient With Systemic Lupus Erythematosus: A Case Report

Systemic lupus erythematosus (SLE) is an autoimmune disease with multiorgan involvement, being the development of neuropsychiatric (NP) symptoms variable, in which the presentation of catatonia and Cotard syndrome (CoS) is rare.

We report the case of a 29-year-old woman who was diagnosed with SLE in 2018 based on the presence of articular, serosal and, hematological manifestations and immunological abnormalities. During her hospitalization, inappropriate behaviors including repetitive and incoherent speech, visual and olfactory hallucinations developed, so NP involvement was considered, and quetiapine and methylprednisolone pulses were administered with good response. The patient was discharged to the care of her family, being stuporous, bradypsychic, with thought blockages and nihilistic delusions; in consequence, she was diagnosed with Cotard syndrome (CoS). Moreover, she presented symptoms of catatonia including mutism, catalepsy and rigidity. Treatment consisted of diazepam, aripiprazole 30mg/day, fluoxetine 20mg/day and prednisone 60mg/day.

Catatonia can be a manifestation of NPSLE in active SLE. Catatonic symptoms and CoS in NPSLE have never been described. This is the first report of a SLE patient exhibiting CoS and catatonia.