# An Adolescent Presenting With Mania and Catatonia Associated With Coronavirus Disease-2019 Encephalitis

## TL;DR

A 16-year-old boy with no psychiatric history developed mania and catatonia linked to undiagnosed COVID-19 encephalitis, highlighting unusual neuropsychiatric symptoms of the disease.

## Contribution

Reports a rare case of COVID-19 encephalitis presenting as mania and catatonia in an adolescent without prior psychiatric illness or typical infection symptoms.

## Key findings

- The patient's symptoms were linked to COVID-19 encephalitis after initial negative tests and atypical presentation.
- Treatment with lorazepam, immunoglobulin, and antiviral therapy led to improvement.
- The case underscores the need to consider encephalitis in adolescents with sudden psychiatric symptoms during the pandemic.

## Abstract

There is growing evidence that coronavirus disease-2019 (COVID-19) infection may have various neuropsychiatric manifestations and long-term outcomes. In this article, the authors report a rare case of a 16-year-old male with no previous history of psychiatric illness who presented with an acute manic episode, including laughing for no evident reason, talking to himself, isolation, irritability, sleeplessness, decreased appetite, prolonged staring episodes, having delusions about being harmed or controlled, and aggression. Despite initiating outpatient treatment with a mood stabilizer and antipsychotic for presumed bipolar disorder with psychotic features, his symptoms worsened, and he became catatonic with a decreased level of consciousness, leading to his hospitalization on day 10. Although he had not shown typical evidence of infection with COVID-19 in the days leading up to or during his hospitalization and his initial COVID-19 test was negative, his COVID-19 test was positive on day 14, and his chest X-ray showed infiltrations. His acute manic symptoms and catatonia were identified to be associated with COVID-19 encephalitis after excluding other causes. He responded well to treatment with lorazepam for catatonia and a course of intravenous immunoglobulin, methylprednisolone, and remdesivir for COVID-19 encephalitis. This case demonstrates the workup and treatment of a rare neuropsychiatric manifestation of COVID-19 encephalitis in an adolescent, which started with no past psychiatric history and no typical symptoms of COVID-19 infection.