Catatonic Behavior, Viral Encephalopathy, and Death: The Problem of Fatal Catatonia

The etiology of fatal catatonia, characterized by an agitated psychosis of acute onset which frequently ends in hyperthermia and death, has puzzled clinicians for many years. Controversy has centered around its relationship to schizophrenia. A case report is presented of a man who seemed to have acute schizophrenia, later developing catatonic features; he became hyperthermic and died after nine days despite electroconvulsive therapy and medical support. Postmortem examination revealed microscopic changes in the central nervous system consistent with viral encephalitis. We suggest fatal catatonia may on occasion be the result of a virus acting on the limbic area in particular. Psychiatric presentation and rapid deterioration would create difficulties in diagnosis and management.