Diaphragmatic paralysis due to Lyme disease

Abstract

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 . 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. Eur Respir J 1999; 13: 700±702.

Confirmed cases of Neuroborreliosis with involvement of peripheral nervous system

“…Surprisingly, even if individual cases of diaphragmatic paralysis have been reported,[ 26 27 ] we observed a high frequency (18.6%) in our series and therefore believe that this symptom is suggestive of neuroborreliosis. Conversely, only one of our patients, with a history of myocarditis, developed organ involvement outside the PNS.…”

Idiopathic phrenic neuropathies: A case series and review of the literature

“…One of the BPN patients in the personal series (patient 15) had a history of tick bite, followed by erythema migrans and high IgG titers against Borrelia burgdorferi in the cerebrospinal fluid and blood serum at the time of respiratory failure due to BPN. Although Lyme disease is a well‐known cause of bilateral facial neuropathies, and rarely also of UPN, no patient with bilateral PN has been described previously. It is not known in this patient whether the BPN was due to a direct or an immune‐mediated attack.…”

Unilateral Diaphragm Paralysis Associated With Neurosyphilis: A Case Report

“…Unilateral diaphragm paralysis due to phrenic nerve palsy is strongly associated with several conditions, such as multiple sclerosis, cervical spinal cord injury, tumor infiltration, motor neuron disease, and idiopathic causes. Previous studies have also reported that herpes zoster virus, pneumonia, and Lyme borreliosis are infectious causes of diaphragm paralysis due to phrenic nerve involvement [8][9][10]. However, phrenic nerve palsy with viral involvement is very rare, particularly in neurosyphilis.…”