A Rare Case of Subacute Sclerosing Panencephalitis Presenting as Schizophrenia - A Case Report

Abstract

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive and
often fatal late neurological manifestation of measles infection which
occurs after a latent period of several years after primary infection in
immunocompetent hosts. It is characterised by mental state changes,
myoclonus and often ataxia. In this case, an 18-year-old male presented
with mood swings, irritability, and cognitive decline, leading to an
initial misdiagnosis of schizophrenia. The misdiagnosis stemmed from
overlapping psychiatric symptoms, such as behavioural changes,
forgetfulness, and decreased attention, as well as the absence of
prominent neurological findings at the onset. The diagnosis is based
on the detection of intrathecal anti-measles antibodies of the IgG class
and the presence of the IgM class of antibodies usually confers a bad
prognosis. Pathological examination reveals inflammatory changes
in brain tissue, gliosis, demyelination and typical inclusion bodies
containing measles viral antigens or RNA.
Electroencephalographic findings in SSPE are highly characteristic
showing bilateral generalised high amplitude slow or sharp-slow wave
complexes. Therapeutic modalities often prove disappointing, the
outcome and prognosis is generally poor and most patients die over a
period ranging from several months to a few years. The cause of death
is generally respiratory tract infection or involvement of brain stem
centres controlling vital functions. Although the incidence of SSPE has
dramatically declined after successful immunisation programmes, it
still occurs in developing countries where coverage is lower. It is very
important to correctly diagnose and manage SSPE and not attribute
the symptoms to a mere psychiatric illness. Further research is highly
needed for early diagnosis and treatment options for these patients
to have a decent quality of life, which at present is difficult.

How to cite this article:

Gaur I. A Rare Case of Subacute Sclerosing Panencephalitis Presenting as Schizophrenia - A Case Report. J Commun Dis. 2024;56(4):94-96.

DOI: https://doi.org/10.24321/0019.5138.202476