Alcohol Withdrawal Induced Malignant Catatonia and Response to Bromocriptine: Case Report

Catatonia and malignant catatonia may result in devastating and life-threatening complications like pulmonary embolisms, pneumonia, deep venous thrombosis, rhabdomyolysis, and even death. There have been documented cases implicating alcohol withdrawal as a significant culprit in catatonia. Here, we provide a unique case report of a patient with a complicated medical course, who subsequently developed malignant catatonia secondary to severe alcohol withdrawal, and was successfully treated using both first line treatment of catatonia (lorazepam), and second-line treatment (bromocriptine). Mr. KR is a 32 year-old male with a psychiatric history significant for severe alcohol use disorder, developed fevers, rigidity and dysarthria throughout his admission despite a full negative infectious workup. He was intubated twice, he received his first doses of bromocriptine 2.5mg BID on day 29 of hospitalization. On day 30, he was extubated, and by day 31 he was afebrile, his rigidity and dysarthria had subsided, and he was able to converse coherently. Further titration of bromocriptine (up to 2.5mg every six hours on days 33-37) showed continued improvement, and the patient was eventually transferred out of the ICU. On day 37, a bromocriptine wean was initiated, which KR tolerated and showed continued improvement with return of some baseline activities and resolution of dysarthria. This case report demonstrates the need for increased suspicion for alcohol withdrawal catatonia in patients with a complicated course of alcohol withdrawal, and illustrates a previously undocumented etiology for malignant catatonia.