title: Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal.
abstract: We report two serious and unusual complications of benzodiazepine withdrawal in a single patient: takotsubo cardiomyopathy and catatonia. This 61-year-old female patient was brought to the emergency department with lethargy and within hours had declined into a state of catatonia. Although there was never a complaint of chest pain, ECG showed deep anterior T-wave inversions and cardiac enzymes were elevated. An echocardiogram was consistent with takotsubo cardiomyopathy. She later received 1 mg of midazolam and within minutes had resolution of catatonic symptoms. Careful history revealed that she had omitted her daily dose of lorazepam for 3 days prior to admission. To our knowledge, the case presented herein is the first report of simultaneous catatonia and takotsubo cardiomyopathy in the setting of benzodiazepine withdrawal. The pathogenesis of both conditions is poorly understood but may be indirectly related to the sudden decrease in γ-aminobutyric acid (GABA) signaling during benzodiazepine withdrawal.
authors.affiliation: Boston University School of Medicine, Boston, MA 02118, USA.
authors.forename: Teng J
authors.initials: TJ
authors.lastname: Peng
authors.affiliation: Department of Internal Medicine, Boston Medical Center, Boston, MA 02118, USA.
authors.forename: Nicholas D
authors.identifier: 0000-0003-2251-4910
authors.initials: ND
authors.lastname: Patchett
authors.affiliation: Department of Internal Medicine, Boston Medical Center, Boston, MA 02118, USA.
authors.forename: Sheilah A
authors.identifier: 0000-0001-9394-1448
authors.initials: SA
authors.lastname: Bernard