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Case Report: Bilateral diaphragmatic dysfunction due to Borrelia Burgdorferi
Suhail Basunaid1, Chris van der Grinten1, Nicole Cobben2
1Department of Respiratory Medicine, Maastricht University, Medical Centre, Maastricht, 6200 MD, Netherlands.
F1000Research
|February 12, 2015
Summary
This case report details a rare instance of bilateral diaphragmatic dysfunction caused by Lyme disease. Early diagnosis and treatment, including non-invasive mechanical ventilation, are crucial for managing this tick-borne illness.
Area of Science:
- Neurology
- Infectious Diseases
- Pulmonology
Background:
- Diaphragmatic dysfunction can present with various symptoms, including orthopnea and nocturnal hypoventilation.
- Lyme disease, a tick-borne illness prevalent in Europe, is caused by Borrelia burgdorferi spirochetes.
- The neurological manifestations of Lyme disease can be diverse and sometimes rare.
Purpose of the Study:
- To report a rare case of bilateral diaphragmatic dysfunction secondary to Lyme disease.
- To highlight the importance of considering Lyme disease in the differential diagnosis of unexplained diaphragmatic dysfunction.
- To discuss the management of diaphragmatic paralysis in the context of Lyme disease.
Main Methods:
- A 62-year-old male presented with flu-like symptoms and was found to have bilateral diaphragmatic weakness.
- Diagnostic workup included fluoroscopy with a positive sniff test to confirm diaphragmatic paralysis.
- Serological tests revealed anti-Borrelia antibodies, confirming Lyme disease, followed by oral doxycycline treatment.
Main Results:
- The patient experienced improvement in nocturnal hypoventilation with chronic non-invasive nocturnal ventilation (cNPPV).
- While diaphragmatic function remained impaired, the patient was no longer fully dependent on ventilatory support.
- Successful treatment of Lyme disease led to symptomatic improvement.
Conclusions:
- Lyme disease is a potential, albeit rare, cause of bilateral diaphragmatic dysfunction.
- Prompt recognition and treatment of Lyme disease are essential for successful outcomes.
- Non-invasive mechanical ventilation (NIV) is a viable treatment option for diaphragmatic paralysis.
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