Introduction: Coronavirus disease 2019, the disease caused by SARS-CoV-2, has contributed to considerable morbidity and mortality in 2020. While respiratory symptoms are predominant in COVID-19, there have been reports of neurologic sequel including central nervous symptoms such as catatonia, which is a complex syndrome of bizarre motor behavior, impaired volition, and vegetative abnormalities. Here we present a case of catatonia as the first symptom in a patient with Covid-19, and his challenging treatment.

Case: We describe a case of concurrent COVID-19 and catatonia in a 43-year old man without any prior psychiatric history, who was hospitalized with loss of consciousness. His symptoms of catatonia improved with the administration of ECT.

Discussion: We highlight the importance of the consideration of catatonia as a possible cause of loss of consciousness in medically ill patients. we investigate the various possible mechanisms of Covid-19 involvement in the development of catatonia and the methods of dealing with a patient with Covid-19 and psychological symptoms admitted in the ICU.

Conclusion: Not only catatonia can co-occur with COVID-19, but it may be the first and only Feature presented in the context of this infection, so it deserves special attention especially in unconscious patients. In medically-ill patients with Covid-19 and catatonia symptoms for which benzodiazepines can’t be administered, ETC use can be considered as a low-complicated and rapid method.