Wilson’s disease-caméléon en psychiatrie: Case Report

BACKGROUND: Psychiatric manifestations are common in Wilson’s disease and may precede manifestations of hepatic and central nervous system in 20% of cases. Most of the times undetected Wilson’s disease is treated as a primary psychiatric illness. We report different psychiatric manifestations in the course of the illness of a Wilson’s disease. CASE PRESENTATION: An eighteen-year-old female presented with poor oral intake, decreased speech output, weakness of all limbs, talking to self and with poor self-care. She was provisionally diagnosed with catatonic schizophrenia but didn’t respond to lorazepam and risperidone. On subsequent evaluation found to have Wilson’s disease. Upon starting D-penicillamine, patient developed Stevens Johnson syndrome. She improved with steroids and zinc acetate and maintained well since then. After 3 years, patient presented with psychotic symptoms of few days which responded well to olanzapine 2.5mg. However, 3 years later she had a depressive episode and showed good response to adding sertraline. Sertraline was stopped because of switch to manic episode. She is maintaining well with the olanzapine 10mg per day and on regular neurology follow up. DISCUSSION: Wilson’s disease may present with catatonia, depressive symptoms, personality and behavioral changes. Persons with Wilson’s disease are more prone to adverse events of psychotropic medication. Hence medication must be used with caution. This case suggests that if any young patient presents with psychiatric symptoms not responding to medication, one should try to investigate for any underlying organic pathology especially Wilson’s disease.