Catatonia secondary to calcineurin inhibitor exposure in a pediatric liver transplant patient

Catatonia is a syndrome characterized by a predominance of neurologic and psychiatric symptoms. There has been sparse but convincing literature building the association between catatonia and aspects of solid organ transplant, however, there have been no cases reported of pediatric catatonia post-hepatic transplant related to cyclosporine. This report summarizes the case of a 12-year-old boy with no preexisting neurodevelopmental concerns or psychiatric illness who received an orthotopic liver transplant secondary to a several year course of hepatic failure due to Budd-Chiari syndrome and went on to develop catatonia along with other neurologic complications. He had a partial response to standard treatments for catatonia; however, it was not until he was switched from a calcineurin inhibitor to another immunosuppressant that his symptoms of catatonia and other neurologic dysfunction fully resolved. Subsequently he was followed for 6 months in the outpatient setting, where he regained and maintained his previous baseline of psychosocial function while tapered off lorazepam conservatively. It is well established that catatonia is underrecognized in medically ill adults, and this is likely the case in pediatric populations as well. Early identification is important to not only begin treatment for catatonia, but to recognize that there is active neurologic dysfunction that may be due to iatrogenic or other exogenous causes.