Diaphragmatic paralysis and respiratory failure as a complication of Lyme disease

There have been five recorded cases of diaphragmatic paralysis as a complication of neuroborreliosis.1–5 Here we report another case of Lyme meningoradiculitis, caused by an identified tick, leading to bilateral diaphragmatic paralysis with an abbreviated course on treatment. A 59 year old female presented with a recent history of abdominal pain and falls because of a weakness in her right leg. She had been complaining of flu-like symptoms with twitches in her back and pain in her right side for a month. She gave a history of recently having been bitten by ticks whilst gardening. There was no history of any recent rash. On the day of presentation, she complained of a mild cough, reduced appetite, abdominal distension, constipation, and dysuria. She was a lifelong smoker but was generally healthy. At presentation her blood pressure was 206/107 mm Hg. There was some epigastric tenderness. She had bruising on her right leg that she associated with the falls. The chest radiograph on admission was unremarkable. Abdominal x ray showed dilated loops of small bowel and a loaded colon. Her only blood abnormality was hyponatraemia at 121 mmol/l. She was admitted for further investigations. On day 3 of admission she became increasingly short of breath and on examination had decreased bibasal air entry. On day 4 her …