A case report describes persistent fever and altered consciousness after correction of severe hyponatremia. Catatonic signs and subsequent lorazepam response informed the authors’ diagnosis.
A forty-nine-year-old man with schizoaffective disorder presented with fever and altered mental status. Severe hyponatremia was corrected, but encephalopathy persisted. Investigations did not identify an infectious or structural explanation.
Mutism, stupor, and echophenomena prompted assessment for malignant catatonia. The authors reported rapid clinical improvement and resolution of fever after lorazepam treatment.
The report describes one patient whose metabolic and psychiatric findings evolved over time. It cannot determine the sensitivity or specificity of lorazepam response for malignant catatonia.
An unrevealing investigation in one case is also not a rule that infection, encephalitis, or a medication-related syndrome can be dismissed in another febrile patient. The clinical features and workup must be interpreted together.
Preserve the timing of sodium correction, fever, motor signs, medication changes, and recovery. The report illustrates why persistent symptoms may require reassessment after a plausible initial explanation is treated. It does not prove that every delayed catatonia diagnosis represents a preventable medication error or that lorazepam alone accounts for the entire recovery.
Original analysis of the supplied journal article, identified as PMC13231243.