Unilateral facial flushing and hyperhidrosis in a 50-year-old woman

• Published in: Canadian Medical Association journal (CMAJ) Vol. 197; no. 19; pp. E536 - E537
• Main Authors: Li, Mao-lin, Li, Kun-yi, Wen, Lan
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Inc 19.05.2025; CMA Impact Inc; CMA Impact, Inc
• Subjects: Aged women; Botulinum toxin; Carotid arteries; Health aspects; Hyperhidrosis; Medical research; Medicine, Experimental; Neurology; Physiological aspects; Practice; Thyroid gland; Veins & arteries; Canada; China
• ISSN: 0820-3946; 1488-2329; 1488-2329
• DOI: 10.1503/cmaj.250097

A 50-year-old woman was presented to a neurology clinic with a 7-year history of recurrent left-sided facial flushing and hyperhidrosis triggered by exercise or hot baths, which resolved within 30-60 minutes of rest. She had no history of trauma and no menopausal symptoms. At rest, her physical examination was normal with no signs of Horner syndrome; the patient reported no pupilary or eyelid abnormalities during the episodes. After exercise, a clear line of demarcation appeared on her face. The left side exhibited vasodilation and sweating, and the right side maintained its normal complexion and was dry. Results from routine blood tests were unremarkable. Computed tomography of the chest; ultrasonography of the carotid artery and thyroid gland; and enhanced magnetic resonance imaging of the head, cervical and thoracic spine, and brachial plexus were all normal. Consequently, she was diagnosed idiopathic Harlequin syndrome. The patient did not receive any treatment. At a follow-up visit, she described the persistent symptoms as not affecting her daily activities.