Abstract. Febrile catatonia remains a mystery as a clinical entity situated between psychiatry, neurology, and infectious diseases. The aim of this case presentation is to describe a 42-year-old male patient with the syndrome of febrile catatonia, during which he experiences serious somatic complication (pulmonary thromboembolism). A one-year prospective follow-up was conducted, including clinical interviews and cognitive assessments. Extensive investigations ruled out an organic cause that might explain the clinical picture, and remission occurred on benzodiazepine therapy. However, a longitudinal follow-up revealed recurrence of catatonic symptoms and only partial response to combined therapy, prompting consideration of additional treatment strategies. The case is discussed in the context of two previously reported cases of febrile catatonia in the Bulgarian literature, highlighting diagnostic challenges and therapeutic considerations from a differential diagnosis perspective.

Key words: febrile catatonia, catatonia, schizophrenia, electroconvulsive therapy, benzodiazepines, pulmonary thrombоembolism

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