title: Black widow spider envenomation, a rare cause of Horner's syndrome.
abstract: Horner's syndrome involves a triad of eyelid ptosis, miosis, and facial anhidrosis that results from disruption of the oculosympathetic pathway. Acquired Horner's syndrome is associated with a variety of medical conditions including Pancoast tumor and carotid dissection. We report the unique case of a 47-year-old man presenting with Horner's syndrome 4 weeks after black widow spider envenomation. Workup did not reveal any alternative explanatory etiology. We hypothesize that late sequelae of black widow spider envenomation secondary to autonomic nerve injury or retrograde axonal transport after mechanical inoculation may have led to an acquired defect in the oculosympathetic pathway resulting in a Horner's syndrome. This case introduces a rare cause of Horner's syndrome and highlights the importance of environmental exposures in the evaluation of these patients.
authors.affiliation: Department of Neurology, Wake Forest Baptist Health, Winston-Salem, NC, USA. rstrowd@wfubmc.edu
authors.forename: Roy E
authors.initials: RE
authors.lastname: Strowd
authors.forename: Blake
authors.initials: B
authors.lastname: Scott
authors.forename: Francis O
authors.initials: FO
authors.lastname: Walker
mesh_terms: D000818:Animals; D001740:Black Widow Spider; D006732:Horner Syndrome / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D001098:Spider Bites / Q000150:complications* / Q000175:diagnosis; D013111:Spider Venoms / Q000009:adverse effects*
chemical_list: D013111:Spider Venoms; C038599:black widow spider venom