Medical case narrative
A 19-year-old on a psychiatric ward whose catatonia lifted on steroids
What happened
A 19-year-old girl in Chennai, India (unnamed in the published report), had three months of seizure-like episodes — loss of consciousness, tonic-clonic movements of all limbs, upward rolling of the eyeballs, tongue biting, confusion afterwards; later episodes with chanting followed by minutes of unresponsiveness she could not remember; myoclonic jerks. She was then admitted to a psychiatric ward and managed as a primary behavioural and catatonic illness: benzodiazepines, then injectable lorazepam, then oral olanzapine escalated from 5 mg/day to 15 mg/day over the following days — without improvement — before an autoimmune workup was done. The report records no formal schizophrenia or bipolar label for her; the psychiatric framing is shown by the ward and the escalating antipsychotic trial, and this entry words it that way.
What it looked like
Acute confusion and psychomotor agitation lasting three days; catatonic signs — posturing, echopraxia, echolalia, ambivalence; aimless pacing, dancing, and crawling like a snake; disorientation; sleep and communication so poor she needed help with personal hygiene. Her EEG, brain MRI, and spinal fluid were all normal.
What the labs found
Infection was ruled out, and evaluation for autoimmune encephalopathies found very high serum anti-TPO antibodies — 1261.4 U/mL, against a normal of under 60 — despite a euthyroid status (the report states she was euthyroid but prints no numeric TSH or T4 for her, so none is quoted here). Voltage-gated potassium channel antibodies were negative. The diagnosis made was Hashimoto's encephalopathy, a diagnosis of exclusion, confirmed by the consultant neurologist. Two limitations travel with this entry, both from the authors themselves: the full antibody panel for anti-NMDAR, LGI1, and CASPR2 encephalitis was not done — anti-NMDAR encephalitis was excluded on clinical grounds only — and anti-TPO levels do not correlate with severity or improvement. The sourcing limit travels too: everything in this entry rests on the single published case report; a later paper cites her case only at citation level, as belonging to a class of neurobehavioural presentations, without re-reporting her values or course.
What changed
Injectable lorazepam at 6 mg/day changed nothing over days; olanzapine up to 15 mg/day brought no significant improvement. Then methylprednisolone 750 mg/day intravenously for five days, followed by oral prednisolone — and thereafter, significant clinical improvement. Corticosteroids were tapered over four months and her antipsychotic medications were tapered off; on follow-up she had recovered symptomatically and was functioning well.
The test that told the story
Serum anti-TPO antibody testing — the autoimmune screen that the psychiatric ward's drug ladder had not included.
Sources: Karthik et al. 2017 (primary case report, all values); Das & Reddy 2021 (a different patient's report whose discussion cites this case at citation level only).