RT Journal Article
SR Electronic
T1 Diaphragmatic paralysis due to Lyme disease
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 700
OP 702
DO 10.1183/09031936.99.13370099
VO 13
IS 3
A1 JL Faul
A1 S Ruoss
A1 RL Doyle
A1 PN Kao
YR 1999
UL http://erj.ersjournals.com/content/13/3/700.abstract
AB Lyme disease is a tick-borne spirochaete infection which, in a proportion of patients, can lead to neuropathy. This article describes a case of diaphragmatic paralysis due to Lyme disease. A 39-yr-old male presented to the hospital because of an acute left facial palsy. Six weeks prior to admission he had developed a circular rash on his left flank during a camping holiday. He also complained of shortness of breath and arthralgia for 1 week. His chest radiograph demonstrated a raised right hemi-diaphragm. Diaphragmatic paralysis was confirmed by fluoroscopy (a positive sniff test). Serology revealed evidence of recent infection by Borrelia burgdorferi. On the basis of the patient's clinical presentation, a recent history of erythema migrans, and positive Lyme serology, a diagnosis of neuroborreliosis was made. He received oral doxycycline therapy (200 mg x day(-1)) for three weeks. Facial and diaphragmatic palsies resolved within eight weeks. On the basis of this case, a diagnosis of Lyme disease should be considered in patients from endemic regions with otherwise unexplained phrenic nerve palsy.