Lateral Trunk Dystonia Induced by Metoclopramide and Codeine in an Adolescent Patient: Retrospective Report and Experience in a High Resolution Primary Emergency Care (Sar)

Introduction: Lateral trunk dystonia or Pisa Syndrome constitutes a rare neurological adverse reaction primarily associated with antipsychotics. Its presentation in adolescents due to metoclopramide combined with codeine represents an exceptional clinical event with limited documentation in medical literature, especially in the context of emergency care and resolution services (SAR).  Objective: To retrospectively report the case of an adolescent who developed severe lateral dystonia following treatment with metoclopramide and codeine, describing the management experience in an emergency care and resolution service (SAR) and the therapeutic response to intravenous diazepam.  Methodology: Retrospective case report of a 16-year-old patient initially seen in outpatient consultation and subsequently in the Emergency Care and Resolution Service (SAR) during March 2024. Clinical records, evolution during observation, and post-discharge follow-up were analyzed. A systematic literature review of similar cases in adolescents was conducted.  Results: After 48 hours of outpatient treatment (total metoclopramide 60mg, total codeine 120mg) for gastroenteritis and bronchitis, the patient presented marked lateral inclination of the trunk to the right with evident paravertebral contracture. Administration of intravenous diazepam (5mg) in the SAR produced significant improvement in 30 minutes and complete resolution in six hours, without complications. Literature review identified only 12 similar cases in patients under 18 years in the last 10 years.  Conclusions: Adolescents can develop lateral dystonia with standard therapeutic doses of metoclopramide, especially in combination with opioids. Intravenous diazepam constitutes an effective and safe treatment manageable in emergency care and resolution services. Special vigilance is required when prescribing metoclopramide in pediatric populations and training of SAR personnel for recognition of these complications.