Bilateral Adie's Tonic Pupil With Anhidrosis and Hyperthermia

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Abstract
Although Adie's tonic pupil (ATP) most commonly appears as a monosymptomatic illness, it may also be one of many signs of autonomic dysfunction. We will describe a patient with ATP, segmental anhidrosis, and hyperthermia. REPORT OF A CASE A 30-year-old graduate student was brought to the Emory University Hospital in July 1979, because he became prostrate while playing volleyball in the summer heat (temperature, 31.7 °C; humidity, 93%). He had a history of heat intolerance since 15 years of age when he had first noted a total absence of sweating on his left shoulder. Over the course of many years thereafter, he noted multifocal zones of anhidrosis on his left leg, right side of his face, right thigh, and abdomen. He had no history of impotence, dry mouth, or bowel or bladder difficulties. On examination in the emergency room, the patient had an oral temperature of 39.4 °C, pulse of