title: Case Report: Bilateral diaphragmatic dysfunction due to Borrelia Burgdorferi.
abstract: CONCLUSIONS
  In this case report we describe a rare case of bilateral diaphragmatic dysfunction due to Lyme disease.
  
  
  METHODS
  A 62-years-old male presented to the hospital because of flu-like symptoms. During initial evaluation a bilateral diaphragmatic weakness with orthopnea and nocturnal hypoventilation was observed, without a known aetiology. Bilateral diaphragmatic paralysis was confirmed by fluoroscopy with a positive sniff test. The patient was referred to our centre for chronic non-invasive nocturnal ventilation (cNPPV). Subsequent investigations revealed evidence of anti- Borrelia seroactivity in EIA-IgG and IgG-blot, suggesting a recent infection with Lyme disease, and resulted in a 4-week treatment with oral doxycycline. The symptoms of nocturnal hypoventilation were successfully improved with cNPPV. However, our patient still shows impaired diaphragmatic function but he is no longer fully dependent on nocturnal ventilatory support.
  
  
  CONCLUSIONS
  Lyme disease should be considered in the differential diagnosis of diaphragmatic dysfunction. It is a tick-borne illness caused by one of the three pathogenic species of the spirochete Borrelia burgdorferi, present in Europe. A delay in recognizing the symptoms can negatively affect the success of treatment. Non-invasive mechanical ventilation (NIV) is considered a treatment option for patients with diaphragmatic paralysis.
authors: Department of Respiratory Medicine, Maastricht University, Medical Centre, Maastricht, 6200 MD, Netherlands.
authors: Suhail
authors: S
authors: Basunaid
authors: Department of Respiratory Medicine, Maastricht University, Medical Centre, Maastricht, 6200 MD, Netherlands.
authors: Chris
authors: C
authors: van der Grinten
authors: Department of Respiratory Medicine, Maastricht University, Medical Centre, Maastricht, 6200 MD, Netherlands ; Centre of Home Mechanical Ventilation, Maastricht University, Medical Centre, Maastricht, 6200 MD, Netherlands.
authors: Nicole
authors: N
authors: Cobben
authors: Centre of Home Mechanical Ventilation, Maastricht University, Medical Centre, Maastricht, 6200 MD, Netherlands.
authors: Astrid
authors: A
authors: Otte
authors: Centre of Home Mechanical Ventilation, Maastricht University, Medical Centre, Maastricht, 6200 MD, Netherlands.
authors: Roy
authors: R
authors: Sprooten
authors: Department of Respiratory Medicine, Maastricht University, Medical Centre, Maastricht, 6200 MD, Netherlands.
authors: Rohde
authors: R
authors: Gernot
keywords: Borrelia burgdorferi; Lyme disease; diaphram; hypoventilation