When Psychosis Masks Neurodegeneration: A Case of Sporadic Creutzfeldt-Jakob Disease.

We present a diagnostically challenging case of a 57-year-old male with new-onset persecutory delusions, hallucinations, functional decline, and gait instability following recent travel. While psychiatric features are recognised in Creutzfeldt-Jakob disease (CJD), they are often underappreciated as initial manifestations, leading to misdiagnosis and delayed recognition. Initially suspected to have a primary psychotic disorder, the patient's rapidly progressive course, neurological signs, characteristic MRI findings, and positive cerebrospinal fluid (CSF) real-time quaking-induced conversion (RT-QuIC) confirmed a diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD). This case underscores the need to consider organic and neurodegenerative etiologies in patients with acute psychiatric symptoms and gait disturbance.