When Burns Lead to Silence: Catatonia — A Case Report

Authors:
Carlos Semprun, Gabriel Bensimon, Shahriar Shahrokhi, Margarita Elloso

Body of Abstract:
Background:
Burn patients frequently develop infectious complications that can manifest with altered mental status, most commonly sepsis associated encephalopathy (SAE). This overlap can obscure the diagnosis of catatonia, a neuropsychiatric syndrome that requires distinct management. Limited literature exists describing catatonia in the setting of severe burns and concurrent infection.

Methods:
We present a 68-year-old man with a history of seizure disorder and depression who sustained 26% TBSA scald burns. Following burn excision and grafting, he developed profound psychomotor slowing, mutism, and posturing. His course was complicated by bacteremia and soft tissue infection, prompting broad infectious disease evaluation.

Results:
Despite active infections, the patient’s neurological findings including stupor, negativism, and intermittent decorticate/decerebrate posturing were disproportionate to his infectious status. Comprehensive CNS evaluation (MRI, CSF analysis, serial EEGs) showed no evidence of meningitis, encephalitis, or non convulsive status epilepticus. Infectious complications were appropriately treated with IV antibiotics; however, there was no associated improvement in mental status. Psychiatry consultation led to a diagnosis of catatonia. High dose lorazepam, escalated to 4 mg IV four times daily, resulted in progressive and complete resolution of symptoms, confirming the diagnosis.

Conclusion:
Infection related encephalopathy is common in burn patients and can mask or mimic catatonia, delaying recognition and treatment. This case highlights the importance of considering catatonia when mental status fails to improve despite adequate infection management. Early differentiation between infectious etiologies and catatonia is critical, as benzodiazepine therapy can rapidly reverse symptoms and prevent prolonged morbidity. Burn teams should maintain heightened awareness of catatonia when evaluating unexplained neurological deterioration in the context of infection.