Lyme disease is a tick-borne spirochaete infection which, in a proportion o
f patients, can lead to neuropathy. This article describes a case of diaphr
agmatic paralysis due to Lyme disease.
A 39-yr-old male presented to the hospital because of an acute left facial
palsy. Six weeks prior to admission he had developed a circular rash on his
left flank during a camping holiday. He also complained of shortness of br
eath and arthralgia for 1 week. His chest radiograph demonstrated a raised
right hemi-diaphragm. Diaphragmatic paralysis was confirmed by fluoroscopy
(a positive sniff test). Serology revealed evidence of recent infection by
Borrelia burgdorferi, On the basis of the patient's clinical presentation,
a recent history of erythema migrans, and positive Lyme serology, a diagnos
is of neuroborreliosis was made. He received oral doxycycline therapy (200
mg.day(-1)) for three weeks. Facial and diaphragmatic palsies resolved with
in eight weeks.
On the basis of this case, a diagnosis of Lyme disease should be considered
in patients from endemic regions with otherwise unexplained phrenic nerve
palsy.