MERS and Psychotic Attack: Etiology or Comorbidity? A Case Report

MERS and Psychotic Attack

Abstract

Psychotic disorder is characterized by disturbances in thought, perception, movement, and behavior, and can arise from primary psychiatric conditions or underlying medical etiologies. Adolescents presenting with acute psychotic symptoms may be referred directly to psychiatric services without sufficient consideration of differential diagnoses, particularly when initial neurological examination is unremarkable. This case report emphasizes the importance of concurrent evaluation by child and adolescent psychiatry and child neurology in acute/subacute psychiatric presentations through an illustrative case of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). A 17-year-old female presented with a 4-day history of abrupt behavioral changes, hallucinations, disorganized behavior, and self-harming behaviors, culminating in a suicide attempt. Initial neurological examination was normal, and she was first evaluated by psychiatry. Acute agitation required pharmacological control with 10 mg olanzapine, followed by 5 mg haloperidol and 2 mg biperiden intramuscularly. Laboratory tests showed elevated CRP and leukocytosis. Diffusion-weighted MRI demonstrated a focal ovoid restricted diffusion lesion in the splenium of the corpus callosum with corresponding T2-FLAIR hyperintensity, consistent with MERS. Psychotic symptoms steadily remitted, with complete resolution by approximately two weeks after discharge, and no neurological deficits or cognitive impairment at one-month follow-up. This case underscores that abrupt-onset psychosis in adolescents warrants integrated neuropsychiatric assessment and timely neuroimaging to avoid misdiagnosis and delays in appropriate management.