Yan Rong, Dang Chengxue, Yuan Wei
Department of Surgical Oncology, the First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.
Department of Anesthesiology, the First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China.
Transl Cancer Res. 2022 Jul;11(7):2457-2461. doi: 10.21037/tcr-21-2462.
The Harlequin syndrome is an idiopathic, autonomic disorder. It typically presents with unilateral sweating and flushing of the face. It could be caused not only by autonomic dysfunction or space-occupying central neuropathy, but by some clinical interventions as well. Although iatrogenic Harlequin syndrome is rare, clinicians should be aware of this condition to diagnose correctly and provide suitable assistance.
Here we report a case of iatrogenic Harlequin syndrome. The unique part of this case is that this patient presented with successive presentations of Harlequin syndrome on different sides of the body. The patient was a 30-40-year-old woman who had flushing and sweating on one side of the face after intraspinal analgesia. This symptom disappeared on its own after a period of persistence, and reappeared several days later after increasing the dose of the drug injected into the epidural cavity. Interestingly, the second blush appeared on the other side of the patient's face.
Triggered by intraspinal analgesia and manifested in different body parts, Harlequin syndrome is proven here to be derived from iatrogenic stimuli. We believe that the different distribution states of analgesic drugs after entering the spinal canal can promote Harlequin syndrome to manifest in different body parts.
丑角综合征是一种特发性自主神经障碍。其典型表现为单侧面部出汗和潮红。它不仅可能由自主神经功能障碍或占位性中枢神经病变引起，也可能由一些临床干预导致。尽管医源性丑角综合征罕见，但临床医生应了解这种情况以便正确诊断并提供适当帮助。
在此我们报告一例医源性丑角综合征病例。该病例的独特之处在于，该患者身体不同侧先后出现丑角综合征表现。患者为一名30至40岁女性，在椎管内镇痛后一侧面部出现潮红和出汗。该症状持续一段时间后自行消失，在增加硬膜外腔注射药物剂量几天后又再次出现。有趣的是，第二次潮红出现在患者面部的另一侧。
丑角综合征由椎管内镇痛引发且表现在不同身体部位，在此被证明源于医源性刺激。我们认为镇痛药物进入椎管后的不同分布状态可促使丑角综合征表现在不同身体部位。
