A man with an arched back

Abstract

A 19-year-old Chinese man presented with a four-month history of progressive lower back pain and stiffness. He had progressive truncal arching, but no limb, cranial or vocal abnormalities. This affected his ability to walk and fall asleep. His symptoms worsened with anxiety, but improved during deep sleep. Four years prior, he had been diagnosed with depression. He was taking fluoxetine intermittently, but there was no prior neuroleptic exposure. A trial of levodopa/benserazide up to 100 mg twice daily for over three months had no effect. His brother was unaffected, but his father reported feeling a cramping sensation in his dominant hand when writing under stressful conditions – the latter had a bilateral postural hand tremor without overt dystonia on examination.