title: A rash and a rare cause of unilateral diaphragmatic paralysis.
abstract: A 61-year-old man who was an ex-heavy smoker presented to our ambulatory care centre with a 4-week history of dyspnoea on mild exertion. 2 weeks prior to his symptoms, he had developed right-sided cervical herpes zoster for which he was prescribed oral acyclovir by his general practitioner. On examination, a rash over the right C4-5 dermatomes was noted and dullness on percussion of the right mid and lower zones with markedly reduced air entry. His chest radiograph showed a raised right hemi-diaphragm with associated right middle and lower lobe collapse. Further investigation with CT and bronchoscopy did not identify a cause and showed no evidence of underlying malignancy or endobronchial obstruction. An ultrasound 'sniff test' was performed to confirm diaphragmatic paralysis. We present a rare case of cervical herpes-induced diaphragmatic paralysis, and summarise our approach and the current understanding of this interesting condition.
authors.affiliation: University Hospitals of Leicester NHS Trust, Leicester, UK.|Northampton General Hospital NHS Trust, Northampton, UK.
authors.forename: Zakariye M
authors.initials: ZM
authors.lastname: Ashkir
authors.affiliation: University Hospitals of Leicester NHS Trust, Leicester, UK.|Northampton General Hospital NHS Trust, Northampton, UK.
authors.forename: George
authors.initials: G
authors.lastname: Tsaknis
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage; D000639:Amitriptyline / Q000008:administration & dosage; D003964:Diaphragm / Q000502:physiology*; D005076:Exanthema / Q000209:etiology*; D006562:Herpes Zoster / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy; D012133:Respiratory Paralysis / Q000175:diagnosis* / Q000209:etiology / Q000821:virology; D016896:Treatment Outcome
chemical_list: D000639:Amitriptyline; D000212:Acyclovir