title: 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 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.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, CA 94305, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Faul
authors.forename: S
authors.initials: S
authors.lastname: Ruoss
authors.forename: R L
authors.initials: RL
authors.lastname: Doyle
authors.forename: P N
authors.initials: PN
authors.lastname: Kao
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015748:Borrelia burgdorferi Group / Q000302:isolation & purification*; D004318:Doxycycline / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008193:Lyme Disease / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D011859:Radiography; D012133:Respiratory Paralysis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline