Acute Psychotic Episode With Catatonia in an Adolescent With Marfan Syndrome: A Case Report

Neuropsychiatric symptoms of Marfan syndrome (MFS) are rarely described, yet accumulating evidence suggests a possible association with psychotic disorders. We report a 17-year-old male with MFS who, two months after medically indicated sternal repair for Marfan-related skeletal dysplasia, developed an acute psychotic episode with catatonia. Catatonic features on admission comprised mutism, rigidity, negativism, posturing, and food refusal (Bush-Francis Catatonia Rating Scale score 31/69). Psychotic features included persecutory delusions, delusions of immortality, and hallucinatory behaviour. Biographical review revealed longstanding limited autonomy, poor social integration, and reactive body image distress following surgery. After exclusion of organic and toxic causes, a diagnosis of brief psychotic disorder comorbid with mild intellectual disability was established. Benzodiazepine treatment was initiated for catatonia; olanzapine was added on day seven for persistent psychotic features, achieving full remission by day 24, with sustained remission off all medication over three years of follow-up. Three pathogenic axes are discussed as hypotheses - a possible shared genetic vulnerability via fibrillin-1/TGF-β dysregulation; Lujan-Fryns syndrome as an unresolved differential; and a stress-diathesis model in which surgery precipitated decompensation on a background of psychosocial burden and cognitive vulnerability. This case supports systematic psychiatric screening in MFS patients, particularly around major surgical events in adolescence.