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Case Report: Bilateral diaphragmatic dysfunction due to Borrelia Burgdorferi.

Basunaid S, van der Grinten C, Cobben N, Otte A, Sprooten R, Gernot R - F1000Res (2014)

Bottom Line: The symptoms of nocturnal hypoventilation were successfully improved with cNPPV.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Maastricht University, Medical Centre, Maastricht, 6200 MD, Netherlands.

ABSTRACT

Summary: In this case report we describe a rare case of bilateral diaphragmatic dysfunction due to Lyme disease.

Case report: 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.    

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus

(a) Frontal chest radiograph during initial presentation. (b) Lateral chest radiograph during initial presentation.
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f1: (a) Frontal chest radiograph during initial presentation. (b) Lateral chest radiograph during initial presentation.

Mentions: The chest radiographs (Figure 1a and 1b) demonstrated an elevated left hemi-diaphragm. Screening of diaphragmatic movement during fluoroscopy with sniff manoeuvres revealed a paradoxical movement of both hemi-diaphragms (Figure 2). A pulmonary function test revealed a decrease in supine vital capacity of more than 20% of predicted (Table 2). Arterial blood gases showed pH 7.40, PaCO2 4.9kPa, PaO2 7.8kPa, HCO3 24.6 mmol/l, base excess -0.2 mmol/l. Antibodies to extractable nuclear antigens SSA, SSB, RNP, Sm, SCL-70, Jo-1 and serology of Q-fever were negative. IgG antibodies toB. burgdorferi were detectable in serum.


Case Report: Bilateral diaphragmatic dysfunction due to Borrelia Burgdorferi.

Basunaid S, van der Grinten C, Cobben N, Otte A, Sprooten R, Gernot R - F1000Res (2014)

(a) Frontal chest radiograph during initial presentation. (b) Lateral chest radiograph during initial presentation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4309166&req=5

f1: (a) Frontal chest radiograph during initial presentation. (b) Lateral chest radiograph during initial presentation.
Mentions: The chest radiographs (Figure 1a and 1b) demonstrated an elevated left hemi-diaphragm. Screening of diaphragmatic movement during fluoroscopy with sniff manoeuvres revealed a paradoxical movement of both hemi-diaphragms (Figure 2). A pulmonary function test revealed a decrease in supine vital capacity of more than 20% of predicted (Table 2). Arterial blood gases showed pH 7.40, PaCO2 4.9kPa, PaO2 7.8kPa, HCO3 24.6 mmol/l, base excess -0.2 mmol/l. Antibodies to extractable nuclear antigens SSA, SSB, RNP, Sm, SCL-70, Jo-1 and serology of Q-fever were negative. IgG antibodies toB. burgdorferi were detectable in serum.

Bottom Line: The symptoms of nocturnal hypoventilation were successfully improved with cNPPV.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Respiratory Medicine, Maastricht University, Medical Centre, Maastricht, 6200 MD, Netherlands.

ABSTRACT

Summary: In this case report we describe a rare case of bilateral diaphragmatic dysfunction due to Lyme disease.

Case report: 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.    

Conclusion: 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.

No MeSH data available.


Related in: MedlinePlus