A few tic-related symptoms that manifest in handwriting have been previously reported in TS. These include echographia, the pathological rewriting of phrases produced by the reader; coprographia, the compulsive writing or drawing of obscenities; and paligraphia, the abnormal repetition of written letters, words, or phrases, often in the form of written jocularity.3 It is unclear, however, whether the writing abnormality observed in this patient is a manifestation of TS or a comorbid OCS, as, in clinical settings, it is often difficult to distinguish complex tics from compulsions.4 Repetitive behaviors are commonly reported in TS as part of the tic-related clinical spectrum, including repetitive counting (arithmomania), checking, and “evening-up” behaviors, which are characteristically driven by concerns for symmetry and ‘just-right’ perceptions.4,5 Interestingly, our patient did not report other OCSs and did not respond to fluoxetine. He was unwilling to try other serotonergic or antidopaminergic medications for tic management. Taken together, these observations suggest that this peculiar handwriting abnormality is to be added to the multifaceted tic repertoire ascribed to TS. To the best of our knowledge, this is the first report of a complex tic-related symptom potentially affecting key components of daily functioning by interfering with otherwise proficient writing skills.