Catatonia associated with seronegative autoimmune encephalitis: a case report

Seronegative autoimmune encephalitis is a subgroup of encephalitis with suspected immunologic origin but with no identifiable pathogenic autoantibody in serum or cerebrospinal fluid (CSF).

A 14-year-old girl presented with features suggestive of catatonia and altered mental status without any previous medical or psychiatric history and was subsequently diagnosed with seronegative autoimmune encephalitis. The patient showed notable improvement after immunomodulators (methylprednisolone) and lorazepam were initiated.

The absence of typical presentation along with absence of detectable serum or cerebrospinal fluid antibodies highlights the diagnostic and therapeutic challenges of autoimmune encephalitis (AE) in pediatric patients.

The absence of detectable serum or cerebrospinal fluid antibodies does not exclude an autoimmune etiology when the clinical picture and supportive EEG findings are consistent with autoimmune encephalitis. Hence, autoimmune encephalitis should be suspected when presented with a rapid onset of psychological symptoms, and early and aggressive immunotherapy is crucial for favorable outcomes.