Respiratory failure secondary to malignant catatonia and Klinefelter pulmonary deficits: Successful electroconvulsive therapy

Catatonia is a motor syndrome associated with disorders in behavior. Malignant catatonia (MC) is the form of acute catatonia dominated by fever and autonomic instability that may be fatal if inadequately treated. We present a case of MC complicated by respiratory failure in a patient with previously undiagnosed Klinefelter syndrome. Patients with Klinefelter syndrome have one or more extra X-chromosome(s), and mental illness is a recognized association. The use of electroconvulsive therapy in these patients is well recognized, however, to our knowledge, this report is the first for MC in Klinefelter syndrome. We also describe, for the first time, type II respiratory failure as a secondary phenomenon occurring because of the combination of MC and thoracic abnormalities associated with Klinefelter syndrome. Interestingly, this is only the fourth reported case of respiratory failure due to any cause in MC. The positive outcome in this case confirms the efficacy of electroconvulsive therapy for MC and supports its safety for use in patients with Klinefelter syndrome and in those with secondary respiratory failure.