title: A 62-year-old man with dyspnea.
abstract: We describe the case of a 62-year-old man who presented with shortness of breath that had progressed over several years. He had a history of a paralyzed right hemidiaphragm for at least the previous 10 years. He also reported weakness in his proximal legs and daytime sleepiness. On examination, he was found to have thoracoabdominal paradox when in supine position. Pulmonary function testing revealed severe restriction; arterial blood gas showed chronic respiratory acidosis. Electromyography showed chronic phrenic neuropathy bilaterally, with mild proximal myopathy. Serum aldolase level was mildly elevated, but serologic tests for connective tissue disorders were within reference range. After extensive clinical investigations, the patient was found to have severely reduced acid α-glucosidase. Genetic analysis confirmed the diagnosis of adult-onset Pompe disease. The patient started treatment with bilevel positive airway pressure titrated during polysomnography, and acid α-glucosidase enzyme replacement was recommended.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
authors.forename: Misbah
authors.initials: M
authors.lastname: Baqir
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, United States.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Sorenson
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Olson
keywords: Acid α-glucosidase enzyme; Bilevel positive airway pressure; Enzyme replacement therapy; FRC, functional residual capacity; Forced vital capacity; GAA, acid α-glucosidase; Glycogen storage disease; Pompe disease