Case Of Subacute Sclerosing Pan-Encephalitis (Sspe) Presenting As Catatonic Schizophrenia

Index case presented with insidious onset psychotic symptoms of 6 months duration characterised by excitement, smiling and muttering to self, catatonic posturing, negativism, and 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. 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 anti-measles antibody as measured by EIA was positive in high titres (15586 U/ml and 8457 U/ml respectively). A diagnosis of SSPE stage 2 was kept. This case demonstrates that SSPE can masquerade as catatonic schizophrenia in early stages.