Case of Subacute Sclerosing Pan-Encephalitis (SSPE) presenting as catatonic schizophrenia

Abstract

A 15-year-old boy presented with insidious onset psychotic symptoms of 6 months duration characterised by excitement, smiling and muttering to self, catatonic posturing, negativism, periods of mutism, irritability, episodes of aggression and poor self care which were gradually progressive in nature. For the last 2 months preceding his presentation to the clinic he developed myoclonic jerks predominantly involving the trunks and upper limbs and apraxia. There was marked decline in scholastic performance over a relatively shorter period of time. On examination, there was generalised cognitive impairment, subcortical myoclonus occurring every 2-3 minutes, paratonia and echolalia. Non contrast Magnetic Resonance Imaging (MRI) Brain study was unremarkable. Electroencephalogram (EEG) showed slow background and periodic generalised slow waves. His cerebrospinal fluid (CSF) and serum antimeasles antibody as measured by EIA was positive in high titres (15586 U/ml and 8457 U/ml respectively) [Image 1]. A diagnosis of SSPE stage 2 was kept. This case highlights that SSPE can present with symptoms suggestive of catatonic schizophrenia even in initial stages.