Madison Area Lyme Support Group

In a letter to the editor, entitled “Atypical presentation of Lyme disease,” Jarosińska and colleagues describe a unique case of a diaphragm paralysis caused by Lyme disease. [1]

According to the authors, diaphragm paralysis as a complication of Lyme disease was first reported in 1986. Since then, there have only been 4 cases involving bilateral paralysis of the diaphragm, which can cause breathing problems in patients.  “… the presented case will be the fifth described case of bilateral diaphragmatic paralysis in the course of probable Lyme neuroborreliosis.”

Patients with this condition experience weakness of the diaphragm and “have reduced breathing capabilities or are unable to control their voluntary breathing. They also have difficulty maintaining adequate gas exchange, as the lungs are not able to inhale and exhale outside air as efficiently.”²

Lyme disease causes breathing problems

A 64-year-old man exhibited symptoms of acute respiratory failure when lying on his back and complained of dyspnea, breathing difficult during sleep, and pain in the cervical spine, which had been ongoing for about one month.

“Upon admission, physical examination revealed tachypnea, a thoracic breathing pattern, and increased respiratory effort with the activation of accessory respiratory muscles, without any signs of an acute respiratory infection,” the authors state.

A cardiac exam revealed bilateral phrenic nerve palsy and the patient was transferred to the neurology department for further testing, which revealed no significant abnormalities.

Infectious Disease Testing

“The diagnostic process was broadened and serological analysis was carried out to test for a number of antibodies,” including those specific to Lyme disease, the authors state.

Test results were positive for Lyme disease. However, there was no history of a tick bite.

“Hence, the patient was diagnosed with bilateral phrenic nerve palsy in the course of probable Lyme neuroborreliosis,” the authors state.

The patient was treated with IV ceftriaxone, followed by oral doxycycline.

“During the hospitalization, partial clinical improvement was achieved and the patient was discharged home in a stable condition without any respiratory support.”

According to the authors, “palsy of the phrenic nerve in the course of [Lyme neuroborreliosis] is a rare and unique symptom.”

However, “it seems reasonable to consider serological diagnostics for Lyme disease in patients with diaphragmatic paralysis of undetermined etiology.”