[version 1; referees: 2 approved]
diafragma is het middenrif.
Suhail Basunaid1, Chris van der Grinten1, Nicole Cobben1,2, Astrid Otte2, Roy Sprooten2, Rohde Gernot1
In this case report we describe a rare case of bilateral diaphragmatic dysfunction due to Lyme disease.
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.
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.
Patients with bilateral diaphragmatic paralysis may initially present with dyspnea, orthopnea, and as the disease progresses respiratory failure. Bilateral diaphragmatic paralysis is a severe generalized muscle weakness, however in few cases it has been observed that the diaphragm can be the only involved organ. The most common causes of bilateral diaphragmatic paralysis are damage to the phrenic nerves and generalized muscle diseases. Nocturnal ventilatory assistance may have a significant beneficial effect6. These patients show reduced ventilatory muscle strength, as measured by maximal inspiratory and trans-diaphragmatic pressures. These symptoms could improve in association with an improved functional score and decreased dyspnea under ventilatory assistance. Non-invasive positive pressure ventilation (NPPV) is the therapeutic tool of choice for symptomatic patients with bilateral diaphragmatic paralysis.
This case report describes the development of diaphragmatic paralysis in a patient with Lyme disease with the need for ventilatory support3,4.
First published: 06 okt 2014, 3:235 (doi: 10.12688/f1000research.5375.1)
Competing interests: The abstract describing this work has been presented at the European Respiratory Society Annual Congress 2013.