SEVERE ASTHMA COMPLICATED BY BILATERAL DIAPHRAGMATIC PARALYSIS ATTRIBUTED TO PARSONAGE-TURNER SYNDROME

Progressive dyspnea that developed in a 52-year-old woman with a lifel ong history of asthma did not respond to high-dose orally administered glucocorticoids. Initially, a diagnosis of allergic bronchopulmonary aspergillosis or hypersensitivity pneumonia was suggested as the cause of the worsening dyspnea. Pulmonary function tests demonstrated sever e airway obstruction; substantial improvement was noted after bronchod ilator therapy. Maximal inspiratory pressure was decreased, and the di ffusing capacity of the lungs was abnormal. Computed tomography of the chest showed no parenchymal or mediastinal abnormalities. During a sn iff test, fluoroscopy of her diaphragm disclosed paradoxical motion of both hemidiaphragms during inspiration, consistent with bilateral hem idiaphragmatic paralysis. Parsonage-Turner syndrome was diagnosed. The dose of glucocorticoids was tapered. Follow-up of the patient by tele phone contact in March 1994 (9 months after her initial examination at our clinic) revealed that the dyspnea was still severe.