Catatonia as the initial manifestation of neuropsychiatric lupus

Catatonia is a rare neuropsychiatric syndrome that has been exceptionally described as the initial manifestation of systemic lupus erythematosus (SLE). We report the case of a 32-year-old woman who presented with severe catatonia, autoimmune hemolytic anemia, and lupus hepatitis as the first expression of SLE. Positive ANA, anti-SM, and anti-ribosomal P antibodies, elevated anti-dsDNA with low complement, and a SLEDAI-2 K score of 8 supported the diagnosis. Antiphospholipid antibodies were negative. The patient received high-dose corticosteroids, cyclophosphamide, hydroxychloroquine, and lorazepam, with marked improvement after three days and complete recovery within two weeks, remaining relapse-free during follow-up. This case emphasizes the importance of considering catatonia as an initial manifestation of neuropsychiatric SLE and highlights the diagnostic relevance of anti-ribosomal P antibodies in such presentations.