An acute dystonic episode in a 15-year-old girl during cocaine withdrawal is reported from the Departments of Neurology and Psychiatry, Albert Einstein College of Medicine, Bronx, N.Y. After 16 hours of observation in the hospital without receiving any drugs, she developed generalized dystonia, torticollis, extensor posturing, and high-pitched vocalizations. The episode subsided after administration of 50 mg IV diphenhydramine. She was discharged nine days later with diagnosis of adjustment disorder with depressed mood, and cocaine abuse. 
COMMENT. There is a high frequency of neuroleptic-induced dystonia reported in cocaine users. Cocaine may lower the threshold to these reactions. This report indicates that dystonic reactions to cocaine withdrawal can occur in the absence of other drugs.