Introduction: Malignant catatonia is thought to be due to a severely decreased central dopaminergic activity of a medical, psychiatric, toxic-pharmacologic or idiopathic origin.
Clinical case: A 24 year-old man presented with a generalized tonic-clonic seizure of focal onset. Within the following 48 hours, he developed agitation and paranoid ideation, which evolved into a severe catatonic syndrome complicated by aspiration pneumonia requiring transfer to Intensive Care Unit (ICU). Complementary tests (CT scan MRI, CSF, blood and urine studies) were negative or could not provide an etiological diagnosis. Initial EEG showed theta and delta waves, originating in the right frontal regions which later generalized. He stayed in ICU for the following three months in a state of catatonic stupor with frequent medical complications. During this time, he was given 27 sessions of electroconvulsive therapy (ECT) that eventually led to a remission of the catatonic syndrome. He was discharged from hospital one month later, fully asymptomatic except for a residuary amnesia, with a final diagnosis of idiopathic malignant catatonia.
Conclusions: The authors have reviewed the management of this syndrome, which can be challenging for the physician because of the wide array of possible etiologies and its potentially lethal nature. A favorable outcome can be expected when ECT is started early, provided the underlying pathological process is treatable and there are no structural lesions in the central nervous system.