title: Mycotic aneurysm presenting as Pancoast's syndrome in an injection drug user.
abstract: Injection drug users frequently present to emergency departments with fever. A careful history and physical examination with attention to anatomic localization of symptoms and signs are often necessary to unmask unusual underlying medical conditions. We report a case of a woman with recent injection drug use who presented with fever, a palpable neck mass, and Pancoast's syndrome. She had been seen recently at the ED of another hospital and discharged with oral antibiotics for presumed cellulitis. A mycotic aneurysm of the subclavian artery causing Pancoast's syndrome was later diagnosed by using computed tomography and angiography. A high index of suspicion for anatomically localized infective processes should always be maintained with febrile injection drug users.
authors.affiliation: Department of Medicine, San Francisco General Hospital, San Francisco, CA. jwtsao@itsa.ucsf.edu
authors.forename: J W
authors.initials: JW
authors.lastname: Tsao
authors.forename: A B
authors.initials: AB
authors.lastname: Garlin
authors.forename: S R
authors.initials: SR
authors.lastname: Marder
authors.forename: R J
authors.initials: RJ
authors.lastname: Haber
mesh_terms: D000328:Adult; D000785:Aneurysm, Infected / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D010178:Pancoast Syndrome / Q000209:etiology*; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis*; D013348:Subclavian Artery; D015819:Substance Abuse, Intravenous