A 17-year-old girl with a history of depression, anxiety, and self-cutting presented with a 2-week history of altered mental status and seizurelike activity. Initially the patient reported an “out-of-body experience” and anxiety associated with tinnitus and insomnia. She also experienced left-sided paresthesia, leading to increasing anxiety, for which she started taking alprazolam with some relief. Her pediatrician initially attributed her symptoms to anxiety and stress. Her symptoms worsened to intermittent episodes of anxiety associated with giddiness, agitation, and auditory and visual hallucinations with paranoid ideation. A week into the disease process she experienced 2 seizurelike episodes described as generalized shaking, eye rolling, and drooling, for which she was hospitalized. Her mother noted that she was doing well but had a sore throat, decreased appetite, and weight loss a few weeks before symptom onset. She also acknowledged that the family had been under a lot of stress with the patient’s father...

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