ABSTRACT
Background: There are many potential neuropsychiatric complications of coronavirus disease (COVID-19). While catatonic presentations were common during past pandemics (e.g. encephalitis lethargica), few case reports have identified this syndrome in patients with COVID-19. Here, we present a case of acute catatonia associated with COVID-19. Case History: The patient was a man in his 60s with a history of hypertension and a distant psychotic episode (20 years ago) who presented to the ED with three days of altered mental status. Symptoms included agitation, verbigeration, insomnia, and refusal of food and water. He was observed at home pacing with his arms outstretched in odd postures. On arrival to the ED, he was diaphoretic, tachycardic, and hypertensive. He was initially mute on interview. Physical examination was notable for staring, perseveration, ambitendency, rigidity, and gegenhalten. Fifteen minutes following a lorazepam challenge, his Bush-Francis Catatonia Rating Scale score decreased from 27 to 9. He quickly became calm, conversant, and better oriented. His laboratory results were notable only for a serum creatine kinase level of 1,187 U/L (530 U/L after fluid administration) and a positive PCR test result for COVID-19. Brain MRI showed mild probable microvascular ischemic disease. EEG and additional serologies were normal. Lumbar puncture was not obtained. The patient was discharged on a lorazepam taper on hospital day 4 with a recommendation for outpatient psychiatric follow-up. Conclusion: Catatonia is a potential complication of COVID-19. Our case is consistent with the literature demonstrating catatonia responds at high rates to benzodiazepine treatment, regardless of its etiology.