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Final Program


Final Program

407 - A Rare Case of Lyme Neuroborreliosis Causing Orthopnea

Friday, February 28, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • LS

    Lillian Sidky, BS

    Medical Student
    Tufts University School of Medicine
    Boston, Massachusetts, United States

    • Co-Author(s)

  • FB

    Fiona Beltran, BA

    Medical Student
    Tufts University School of Medicine
    Napa, California, United States

  • JT

    John TenBrook, MD

    Physician
    South Shore Hospital
    Weymouth, Massachusetts, United States

Case Diagnosis: Lyme Neuroborreliosis Affecting the Phrenic Nerve

Case Description: A 63 year old male with a past medical history of hypothyroidism and hyperlipidemia presented to the emergency department with orthopnea after being unable to tolerate lying supine during an outpatient computed tomography scan. His outpatient cardiac workup was unrevealing and chest x-ray on admission was only remarkable for bilateral basilar atelectasis. The prior week, the patient was diagnosed with Lyme disease and started on a course of doxycycline. On physical exam, the patient had decreased sensation from below the chin to the jugular notch.  In supine positioning, the patient’s oxygen saturation immediately decreased. Fluoroscopy sniff test showed limited diaphragmatic motion bilaterally. The patient was diagnosed with Lyme neuroborreliosis affecting the C3 sensory dermatome and C3 motor contribution of the phrenic nerve causing diaphragmatic motor weakness.

Discussions:

This case represents the acute complication of diaphragmatic dysfunction secondary to Lyme neuroborreliosis due to the tickborne bacteria Borrelia burgdorferi. Previously described manifestations of Lyme neuroborreliosis include meningitis, cranial neuritis, and radiculoneuritis, but extent of the disease affecting to the phrenic nerve causing diaphragmatic dysfunction remains rare.1 Previous cases of Lyme neuroborreliosis affecting the phrenic nerve have been successfully treated with IV ceftriaxone. 2,3 

Conclusions:

When evaluating the etiology of orthopnea it is important to consider the primary anatomical structures and their innervations as these may be directly impacted by pathology. In this case, loss of sensation to the C3 dermatome on physical exam was a key finding to localizing the source of orthopnea thus, emphasizing the critical need for a thorough physical examination on all patients with orthopnea.