Mycotic aneurysm presenting as Pancoast's syndrome in an injection drug user

Injection drug users frequently present to emergency departments with fever . A careful history and physical examination with attention to anatomic loc alization of symptoms and signs are often necessary to unmask unusual under lying 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 sy ndrome. She had been seen recently at the ED of another hospital and discha rged with oral antibiotics for presumed cellulitis. A mycotic aneurysm of t he subclavian artery causing Pancoast's syndrome was later diagnosed by usi ng computed tomography and angiography. A high index of suspicion for anato mically localized infective processes should always be maintained with febr ile injection drug users.