Horner’s syndrome in a 16-year-old patient during diabetic ketoacidosis

Marta Baszyńska-Wilk; Julia Przybylak-Ortega; Iga Cytrynowicz; Anna Świercz; Elżbieta Moszczyńska

doi:10.5114/pedm.2026.158648

eISSN: 2083-8441
ISSN: 2081-237X

Pediatric Endocrinology Diabetes and Metabolism

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abstract:

Case report

Horner’s syndrome in a 16-year-old patient during diabetic ketoacidosis

Marta Baszyńska-Wilk

¹

,

Julia Przybylak-Ortega

¹

,

Iga Cytrynowicz

¹

,

Anna Świercz

¹

,

Elżbieta Moszczyńska

¹

Department of Endocrinology and Diabetology, The Children’s Memorial Health Institute, Warsaw, Poland

Pediatr Endocrinol Diabetes Metab 2026; 32

DOI: https://doi.org/10.5114/pedm.2026.158648

Online publish date: 2026/01/21

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Introduction
Diabetic ketoacidosis (DKA) at the onset of newly diagnosed type 1 diabetes (T1D) is associated with neurological complications. Horner syndrome (HS), consisting of miosis, ptosis, and anhidrosis, has not previously been reported during DKA in children.

Case report
The case concerns a 16-year-old patient with newly diagnosed T1D with DKA (pH 6.86, sBE –26.1 mmol/l, HCO3 5.6 mmol/l, glucose 513 mg/dl). Treatment included intravenous insulin therapy and fluid replacement. On the fourth day of hospitalization, pupillary asymmetry and ptosis of the upper left eyelid were observed. Mannitol treatment was introduced; brain computed tomography revealed no abnormalities. After neurological and ophthalmological assessment, a diagnosis of HS as a complication of DKA was made. During a follow-up, 6 months after diagnosis, features of HS continued to be observed, but after 12 months, symptoms gradually resolved.

Conclusions
Neurological evaluations continue to be essential after clinical improvement in DKA; although infrequent, neurological complications can occur.

keywords:

Horner’s syndrome in a 16-year-old patient during diabetic ketoacidosis

Marta Baszyńska-Wilk 1 , Julia Przybylak-Ortega 1 , Iga Cytrynowicz 1 , Anna Świercz 1 , Elżbieta Moszczyńska 1

Horner’s syndrome, diabetic ketoacidosis, diabetes type 1

Marta Baszyńska-Wilk

¹

,

Julia Przybylak-Ortega

¹

,

Iga Cytrynowicz

¹

,

Anna Świercz

¹

,

Elżbieta Moszczyńska

¹