Tardive Oculogyric Dystonia during Concomitant Quetiapine, Fluoxetine and Lithium Therapy: Case Report and Literature Review

Oculogyric crisis (OGC) is an acute paroxysmal sustained dystonia that occurs as an adverse drug event, commonly following first-generation antipsychotics and rarely with second-generation antipsychotics. We report a case of quetiapine (QTP)-induced disabling and stigmatizing tardive OGC developing after a month of its initiation, at a substantive low-dose (100 mg/day) in an ectomorphic young adult female during concomitant QTP, fluoxetine, and lithium therapy. It responded well to anticholinergic medications alone, without the need for dose-reduction or discontinuation of medications. We review literature on OGC due to QTP, fluoxetine and lithium; and discuss putative mechanisms leading to OGC in our case.