Ross syndrome following COVID-19 infection in an 18-year-old Syrian male patient: a case report.

Background: Ross syndrome is an exceptionally rare disorder characterized by tonic pupils, areflexia, and anhidrosis, with a prevalence that appears to be higher in women than in men, typically presenting in individuals during their 30s. While Adie Syndrome closely mimics Ross syndrome, Adie syndrome lacks anhidrosis, making Ross syndrome clinically differentiable. This condition can manifest with a variety of symptoms, including cardiovascular anomalies attributable to autonomic nervous system dysfunction. We present the first case in the literature of COVID-19 being a potential trigger for Ross syndrome.

Case presentation: An 18-year-old Syrian male was evaluated at the ophthalmology clinic owing to progressive bilateral pupillary dilation following a symptomatic COVID-19 infection. Subsequent investigations and a thorough neurological examination revealed tonic pupils and areflexia, leading to an initial diagnosis of Adie syndrome. However, the patient's clinical picture expanded to include diffuse anhidrosis, prompting a revised diagnosis of Ross syndrome (refer to graphical abstract).

Conclusion: Clinicians should remain vigilant regarding the possibility of undefined neurological or ophthalmic sequelae, including Adie syndrome and Ross syndrome, following COVID-19 infection, regardless of the severity of initial symptoms. Further research is warranted to elucidate the underlying mechanisms and to develop appropriate management strategies.