Uemura T, Kasai Y, Araki K, Uchida A
Pisa syndrome. [Journal Article]
J Spinal Disord Tech 2008 Aug; 21(6):455-7.
STUDY DESIGN: Case report.
OBJECTIVE: We report a patient who developed Pisa syndrome (drug-induced pleurothotonus) after treatment with tricyclic antidepressant.
SUMMARY OF BACKGROUND DATA: Pisa syndrome is familiar to neuropsychiatrists, but not to orthopedic surgeons and spinal surgery specialists, both of whom have reported few cases of this syndrome.
METHODS: A 56-year-old woman had experienced feelings of depression and saw a local doctor, where the tricyclic antidepressant clomipramine hydrochloride (9x25 mg tablets daily) was prescribed. From about 2 months after starting medication, she developed flexion of the trunk to the left.
RESULTS: Pisa syndrome was suspected, and then, the daily dose of clomipramine hydrochloride was decreased from 9x to 3x25 mg tablets. Approximately 2 weeks after reducing the dose, abnormal postures gradually improved, and after 1 month, flexion of the trunk resolved.
CONCLUSIONS: We reported a case of Pisa syndrome in which pleurothotonus occurred after treatment with a tricyclic antidepressant and improved after dose reduction. When middle-aged or elderly patients who see orthopedic surgeons display abnormal postures of the trunk, physicians need to ask the patient whether they have received a drug that can cause Pisa syndrome, such as an antipsychotic or antiemetic.
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