Ashkir Zakariye M, Tsaknis George
University Hospitals of Leicester NHS Trust, Leicester, UK.
Northampton General Hospital NHS Trust, Northampton, UK.
BMJ Case Rep. 2017 Mar 1;2017:bcr2016218440. doi: 10.1136/bcr-2016-218440.
A 61-year-old man who was an ex-heavy smoker presented to our ambulatory care centre with a 4-week history of dyspnoea on mild exertion. 2 weeks prior to his symptoms, he had developed right-sided cervical herpes zoster for which he was prescribed oral acyclovir by his general practitioner. On examination, a rash over the right C4-5 dermatomes was noted and dullness on percussion of the right mid and lower zones with markedly reduced air entry. His chest radiograph showed a raised right hemi-diaphragm with associated right middle and lower lobe collapse. Further investigation with CT and bronchoscopy did not identify a cause and showed no evidence of underlying malignancy or endobronchial obstruction. An ultrasound 'sniff test' was performed to confirm diaphragmatic paralysis. We present a rare case of cervical herpes-induced diaphragmatic paralysis, and summarise our approach and the current understanding of this interesting condition.
一名61岁的男性，曾是重度吸烟者，因轻度活动后呼吸困难4周前来我们的门诊护理中心就诊。在出现症状的2周前，他患上了右侧颈部带状疱疹，全科医生给他开了口服阿昔洛韦。检查时，发现右侧C4 - 5皮节有皮疹，右侧中下部叩诊呈浊音，呼吸音明显减弱。他的胸部X光片显示右侧半膈肌抬高，伴有右中、下叶肺不张。进一步的CT和支气管镜检查未发现病因，也未显示有潜在恶性肿瘤或支气管内阻塞的证据。进行了超声“嗅试验”以确诊膈肌麻痹。我们报告了一例罕见的颈部疱疹诱发膈肌麻痹的病例，并总结了我们的处理方法以及对这种有趣病症的当前认识。
