Bon C, Krim E, Colin G, Picard W, Gaborieau V, Gourcerol D, Raherison C
Service des maladies respiratoires, hôpital Haut-Lévêque, centre hospitalier universitaire de Bordeaux, 33600 Pessac, France.
Service de neurologie, hôpital F. Mitterrand, 4, boulevard Hauterive, 64046 Pau, France.
Rev Mal Respir. 2019 Feb;36(2):197-203. doi: 10.1016/j.rmr.2018.07.008. Epub 2019 Jan 31.
Lyme disease is not uncommon and can sometimes progress to neurological complications. We report here an unusual case of bilateral diaphragmatic paralysis secondary to Lyme neuroborreliosis.
A 79-year-old man was admitted to the intensive care unit for acute respiratory distress requiring intubation and the long-term use of nocturnal non-invasive ventilation. Three months beforehand he had been bitten by a tick and developed erythema migrans which was treated with Doxycycline for 10 days. This clinical presentation became complicated a few days later by the progressive onset of severe dyspnoea. At admission, chest radiography revealed bilateral elevation of the diaphragm. Pulmonary function tests revealed a severe restrictive disorder aggravated by decubitus. A diaphragmatic electromyogram showed bilateral axonal polyneuropathy of the phrenic nerves. IgG and IgM antibodies to Borrelia burgdorferi were detectable in serum and cerebrospinal fluid, leading to the diagnosis of Lyme disease. He was treated with intravenous ceftriaxone 2g per day for 21 days, leading to a substantial improvement in symptoms.
In the presence of unilateral or bilateral diaphragmatic paralysis of undetermined aetiology, it seems relevant to perform Lyme serology in the blood and, in positive cases, to follow up with a lumbar puncture in order to detect intrathecal IgG synthesis.
莱姆病并不罕见，有时会进展为神经并发症。我们在此报告一例由莱姆神经疏螺旋体病继发双侧膈肌麻痹的罕见病例。
一名79岁男性因急性呼吸窘迫入住重症监护病房，需要插管并长期夜间使用无创通气。三个月前，他被蜱虫叮咬，出现游走性红斑，用多西环素治疗了10天。几天后，这种临床表现因严重呼吸困难的逐渐出现而变得复杂。入院时，胸部X线检查显示双侧膈肌抬高。肺功能测试显示严重的限制性障碍，卧位时加重。膈肌肌电图显示双侧膈神经轴索性多发性神经病。血清和脑脊液中可检测到抗伯氏疏螺旋体的IgG和IgM抗体，从而诊断为莱姆病。他接受了每天2克静脉注射头孢曲松治疗21天，症状有显著改善。
在病因不明的单侧或双侧膈肌麻痹患者中，进行血液莱姆病血清学检测似乎是合理的，在检测呈阳性的情况下，进行腰椎穿刺以检测鞘内IgG合成。
