• Takeshi Uemura, Yuichi Kasai, Kentaro Araki, and Atsumasa Uchida.
• Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
• J Spinal Disord Tech. 2008 Aug 1; 21 (6): 455-7.

Study DesignCase report.ObjectiveWe report a patient who developed Pisa syndrome (drug-induced pleurothotonus) after treatment with tricyclic antidepressant.Summary Of Background DataPisa syndrome is familiar to neuropsychiatrists, but not to orthopedic surgeons and spinal surgery specialists, both of whom have reported few cases of this syndrome.MethodsA 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.ResultsPisa 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.ConclusionsWe 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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