A case of Wilson’s disease presenting only with somatic preoccupation, suicidal tendencies and auditory hallucinations

Abstract

We hereby report a case of a patient with Wilson’s disease, presenting only with psychiatric symptoms without significant hepatic or neurological symptoms. A 27-year-old woman was admitted to the psychiatric ward with symptoms of somatic preoccupation, auditory hallucinations, suicidal behaviour, regressed behaviour, and severe anxiety. She suffered from paralyzing sensation in both big toes, without any abnormal findings in nerve conduction tests or any neurological signs and symptoms. Also, no significant hepatic impairment was presented. Psychiatric symptoms improved with antipsychotics, mood stabilizers, and other psychotropic agents, but dysphagia and general weakness developed later. She had a family history of Wilson’s disease. High signal intensities in the basal ganglia, midbrain, and pons were observed with fluid-attenuated inversion-recovery (FLAIR) imaging. Based on abnormal findings in the urine copper and serum ceruloplasmin tests, as well as the presence of the ATP7B mutation, a diagnosis of Wilson’s disease was made. Therefore, our case report suggests that future studies should consider the evaluation of psychiatric symptoms in the diagnostic conceptualization of Wilson’s disease.

Keywords

• Diagnostic conceptualization
• psychiatric symptoms
• Wilson’s disease