Case history
A 51-year-old Saudi man presented to us with a 4-week history of right shoulder and chest pain radiating to the back. He also had distal and proximal muscle weakness of the right upper limb.
He is a chronic smoker for 40 years, about three packs per day. His lifetime exposure to tobacco was 120 pack years. He lost about 3 kg in the last 1 week. There was no history of cough or shortness of breath or fever with night sweats.
He had a history of pulmonary tuberculosis 28 years ago and taken complete treatment for 1 year.
On examination, there was ptosis, enophthalmos, narrowing of palpebral fissure and miosis of the right eye and anhidrosis of the right half of the face (figure 1). He also had clubbing of fingers.
Figure 1
Ptosis and miosis in the right eye.
The motor system examination...
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