Pancoast's syndrome secondary to infectious etiologies: a not so uncommon occurrence

Pancoast's syndrome includes Horner's syndrome, atrophy of the hand muscles and shoulder, axilla or arm pain. This syndrome is caused by an apical thoracic lesion, most commonly a bronchogenic carcinoma, which invades the brachial plexus roots and the cervicothoracic sympathetic chain. Several nonmalignant causes are documented in the literature with infection being one. After a case of Pancoast syndrome caused by a methicillin-sensitive Staphylococcus aureus empyema, we began a systematic search of the literature to identify case reports/series of Pancoast syndrome secondary to infection. Our search was limited to the English language and performed using MEDLINE. Thirty-one cases of Pancoast's syndrome secondary to infectious causes were found in our review of the literature. The infectious causes identified were bacterial, fungal and parasitic organisms; however, no single organism could be identified as the most prevalent. Our review represents the most complete summation of individual case reports on this subject and highlights clinical characteristics of each presentation and the organisms that were encountered. This number of cases of Pancoast's syndrome secondary to infectious causes indicates that this association may be more common than previously reported.