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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

Polysomnography with ventilatory support (Bilevel PAP, IPAP=14, EPAP=6, see trace 5).Abdominal and thoracic movements are not completely in-phase because the ventilatory support is not triggered before there is inspiratory flow.
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f4: Polysomnography with ventilatory support (Bilevel PAP, IPAP=14, EPAP=6, see trace 5).Abdominal and thoracic movements are not completely in-phase because the ventilatory support is not triggered before there is inspiratory flow.

Mentions: Ultrasonography showed lack of thickening of the diaphragm with inspiration indicating a non-functioning diaphragm. Polysomnography without ventilatory support showed periods of nocturnal desaturations together with out-of-phase thoracic and abdominal movement (Figure 3 andFigure 4).


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)

Polysomnography with ventilatory support (Bilevel PAP, IPAP=14, EPAP=6, see trace 5).Abdominal and thoracic movements are not completely in-phase because the ventilatory support is not triggered before there is inspiratory flow.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f4: Polysomnography with ventilatory support (Bilevel PAP, IPAP=14, EPAP=6, see trace 5).Abdominal and thoracic movements are not completely in-phase because the ventilatory support is not triggered before there is inspiratory flow.
Mentions: Ultrasonography showed lack of thickening of the diaphragm with inspiration indicating a non-functioning diaphragm. Polysomnography without ventilatory support showed periods of nocturnal desaturations together with out-of-phase thoracic and abdominal movement (Figure 3 andFigure 4).

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