COVID-19 Encephalopathy in the Context of Psychiatric Comorbidity: Case Report and Diagnostic Pitfalls

We present the case of likely COVID-19 associated encephalopathy in a male in his early 50s with a history of non-psychotic depression and personality disorder who presented with delirium, new psychotic symptoms and who developed paratonia and obtundation. After initial questions of neuroleptic malignant syndrome, serotonin syndrome, and stiff person syndrome were decided to not be supported by the clinical picture, conservative management and the repeated treatment of a co-ocurring mastoiditis led to improvement of mental status, regained ability to walk and speak, though a dysexecutive syndrome was left when patient was discharged to rehabilitation services. We explore the role the patient's psychiatric comorbidity had in terms of both his clinical course and the decisions and diagnostic considerations of the various treating teams involved.