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Background
Horner's syndrome (HS) results an obstruction of the oculosympathetic pathway. 1 2 The lesion can occur anywhere along the three-neuron tract, from its central origin to the innervation of the orbit. 1 Miosis and ptosis are the main clinical signs of HS, although iris heterochromia, pupillary dilation and anydrosis may also be seen. 1
Birth trauma is the most common aetiology of congenital HS. Other causes include vascular malformations, congenital neuroblastoma, congenital varicella and ectopic thymus in the neck. 1 2
In the absence of surgery or trauma, acquired HS can be caused by neoplasms (neuroblastoma being most common), arterial disease (dissection and aneurism) or infection. 1 3
Infection is a rare aetiology, but otitis media 4 and intrapleural infections 5 have been associated with HS.
We describe a case of an HS in the context of Bartonella infection with cervical lymphadenopathy.
A detailed clinical history and physical examination may identify the cause of HS.
Case presentation
A 6-year-old healthy boy, living in a rural setting, with regular contact with farm animals (dogs, ducks, rabbits and two new kittens), presented with a painful left cervical mass ( figure 1 ). A week later, he developed ptosis of the left upper eyelid. The family negated any other symptoms at this point. On the 15th day of the illness, the boy was brought to the emergency department. Physical examination confirmed the above findings and revealed ipsilateral miosis ( figure 2 ), multiple bilateral centimetric axillary and inguinal lymph nodes, and a palpable liver border 2cm below the right costal margin. On examination of the skin, he had a scratch on his hand, consistent with cat claws. He had no other focal neurological deficits, such as ophthalmoparesis, hemiparesis or changes, in his mental status.
The diagnosis of an HS was made with assumed cause of external compression, and he was admitted for further evaluation.
Investigations
Laboratory results were within normal values. Serologies for...