Uemura Takeshi, Kasai Yuichi, Araki Kentaro, Uchida Atsumasa
Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
J Spinal Disord Tech. 2008 Aug;21(6):455-7. doi: 10.1097/BSD.0b013e3181570889.
Case report.
We report a patient who developed Pisa syndrome (drug-induced pleurothotonus) after treatment with tricyclic antidepressant.
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.
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.
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.
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.
病例报告。
我们报告一例在接受三环类抗抑郁药治疗后出现比萨综合征（药物性侧胸膜肌张力障碍）的患者。
比萨综合征为神经精神科医生所熟知，但骨科医生和脊柱外科专家对此并不熟悉，他们均报告过少数该综合征病例。
一名56岁女性出现抑郁情绪，就诊于当地医生，医生开具了三环类抗抑郁药盐酸氯米帕明（每日9片，每片25毫克）。从开始用药约2个月后，她出现躯干向左屈曲。
怀疑为比萨综合征，随后，盐酸氯米帕明的每日剂量从9片减至3片，每片25毫克。剂量减少约2周后，异常姿势逐渐改善，1个月后，躯干屈曲消失。
我们报告了一例比萨综合征病例，该病例在接受三环类抗抑郁药治疗后出现侧胸膜肌张力障碍，剂量减少后症状改善。当骨科医生接诊的中老年患者出现躯干异常姿势时，医生需要询问患者是否服用过可导致比萨综合征的药物，如抗精神病药或止吐药。
