A 27-year-old female with elevated CSF protein, dysphagia, tachycardia and psychosis refractory to antipsychotic treatment with an extensive negative workup

Abstract

There are many causes of psychosis. Some of them are medically related while others are psychiatric. In this case we explore causes of psychosis related to mildly elevated CSF protein in a 27 yo patient with unique physical exam findings: dysphagia, tachycardia, and psychosis refractory to antipsychotic treatment (including a moderate 200 mg dose of Clozapine). Ultimately we did not discover any medically known cause of her psychosis, but our final differential diagnosis included an immune mediated encephalitis; possibly as a result of COVID-19, or an unknown medical cause. We find it unlikely that this patient has a primary psychiatric disorder as they had no clinical benefit from Invega Sustenna, Olanzapine, and a moderate 200 mg dose of Clozapine.