Pancoast’s syndrome is a constellation of symptoms and clinical findings, including Horner’s syndrome, atrophy of the hand muscles, and pain in the shoulder, axilla and/or arm. The etiology of Pancoast’s syndrome originates from an apical lung lesion, most commonly a bronchogenic carcinoma, which invades the brachial plexus roots and cervicothoracic sympathetic chain. Several rare non-malignant etiologies are documented in the literature with infection being one.
The authors report the case of a 50-year-old Caucasian male intravenous drug user with a two-week history of right neck, shoulder and arm pain. During the twenty-four hours prior to presentation, he had arm and hand numbness as well as paralysis of the right upper extremity. The patient and his family reported a twenty-four hour history of unequal pupils. Other symptoms included intermittent fever and night sweats for two days and a cough productive of yellow phlegm with occasional streaks of blood. Physical examination and history were consistent with the clinical presentation of Pancoast’s syndrome. Chest imaging revealed a loculated pleural effusion, described as an apical pleural-based irregular opacity extending from the right supraclavicular region to the level of the aortic arch. Additionally, multiple bilateral pulmonary nodules, some with a cavitary component, were seen. Pleural fluid was collected following tube thoracostomy, and cultures grew Methicillin-sensitive Staphylococcus aureus in the pleural fluid, as well as the blood. A methicillin-sensitive Staphylococcus aureus loculated empyema secondary to intravenous drug use was diagnosed as the underlying etiology for the syndrome.
In a comprehensive search of the MEDLINE database and review of individual bibliographies, a total of 30 cases of Pancoast’s syndrome secondary to infectious causes were found in the English literature. A descriptive analysis of case characteristics, such as comorbid conditions, organism, and diagnostic approach was performed. The infectious etiologies identified included a variety of bacterial, fungal and parasitic organisms, but no single organism could be identified as the most prevalent.
This review of the literature represents the most complete summation of individual case reports on this subject. The presence of this number of cases of Pancoast’s syndrome secondary to infectious causes indicates that this association may be more common than previously reported. This review highlights the clinical characteristics of each presentation and the organisms that were encountered.
Heath White, No Financial Disclosure Information; No Product/Research Disclosure Information