Lyme Disease Diaphragm Paralysis: A Rare Cause of Breathing Problems
Diaphragm paralysis as a complication of Lyme disease was first reported in 1986. Since then fewer than five cases of bilateral diaphragmatic paralysis from probable Lyme neuroborreliosis have been documented — making this a rare but important presentation to recognize. For a broader overview of neurologic complications, see neurologic Lyme disease.
What Is Diaphragm Paralysis?
Patients with diaphragm paralysis experience weakness of the breathing muscle that separates the chest from the abdomen. This reduces breathing capacity and impairs the ability to maintain adequate gas exchange.
When both sides of the diaphragm are affected — bilateral paralysis — the impact on breathing is more severe and can lead to acute respiratory failure.
Lyme Disease Breathing Problems: The Case
A 64-year-old man presented with acute respiratory failure when lying on his back, along with difficulty breathing during sleep and cervical spine pain lasting approximately one month. On admission, clinicians observed rapid breathing, a thoracic breathing pattern, and increased respiratory effort using accessory muscles — with no signs of acute respiratory infection.
Cardiac examination revealed bilateral phrenic nerve palsy. The patient was transferred to neurology for further evaluation, which showed no significant structural abnormalities.
Infectious Disease Testing
With no obvious structural cause identified, the diagnostic workup was expanded to include serological testing for multiple pathogens, including Lyme disease. Results were positive for Lyme disease despite no reported history of a tick bite — a pattern seen in a significant proportion of Lyme disease patients.
The patient was diagnosed with bilateral phrenic nerve palsy in the course of probable Lyme neuroborreliosis. This case illustrates how Lyme disease can present without the classic signs of tick exposure or rash. For more on missed and delayed diagnosis, see Lyme disease misdiagnosis.
Treatment and Outcome
The patient was treated with intravenous ceftriaxone followed by oral doxycycline. Partial clinical improvement was achieved during hospitalization and the patient was discharged home in stable condition without respiratory support.
The authors note that phrenic nerve palsy in the course of Lyme neuroborreliosis is rare. However, they conclude that serological testing for Lyme disease is reasonable in patients with diaphragmatic paralysis of undetermined cause.
Frequently Asked Questions
Can Lyme disease cause breathing problems?
Yes. In rare cases, Lyme disease can cause phrenic nerve palsy leading to diaphragm paralysis and acute respiratory failure. Fewer than five cases of bilateral diaphragmatic paralysis from Lyme neuroborreliosis have been reported.
What is phrenic nerve palsy in Lyme disease?
The phrenic nerve controls the diaphragm. When Lyme neuroborreliosis affects this nerve, the diaphragm weakens or becomes paralyzed, impairing breathing capacity and gas exchange.
Should Lyme disease be tested in unexplained diaphragm paralysis?
Yes. When diaphragmatic paralysis has no clear structural or metabolic cause, serological testing for Lyme disease is a reasonable step — particularly in tick-endemic areas.
Clinical Takeaway
Lyme disease is a rare but documented cause of bilateral phrenic nerve palsy and diaphragm paralysis. This case highlights that Lyme neuroborreliosis can present without a tick bite history or classic rash, and that breathing problems may be the primary complaint. Standard neurological and cardiac workups may be unrevealing.
When diaphragmatic paralysis has no identified cause, Lyme disease serological testing should be part of the diagnostic evaluation.
Related Articles
- Neurologic Lyme Disease: Symptoms and Complications
- Lyme Disease Misdiagnosis: Why It Happens
- Autonomic Dysfunction in Lyme Disease
- Sarcoidosis Triggered by Lyme Disease
References
- Jarosińska A, Pilśniak A, Cieśla-Fuławka A, Dziubak W, Siuda J, Holecki MT. Atypical presentation of Lyme disease. Arch Med Sci. 2024;20(1):344–347.
- Columbia University Department of Surgery. Diaphragmatic Weakness and Paralysis. Columbia University Irving Medical Center.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
This could be my problem. 4 years ago I put on 15# (same weight for 40 yrs) after being sick 20 yrs, Lyme diagnosis 11 years ago. Now 20 years ago I said it was like my stomach stopped making noise and working. Now 4 yrs ago my stomach muscles seem not to be working at all, and I’m bloated and it seems abnormal to inflate and get air. I seem to force the air inflation in the cavity.
There are so many causes for each condition. I share this article to include Lyme disease in the evaluation. BTW Lyme can also be a cause of GI issues as an autonomic symptom
This sounds exactly like my story as well. My digestive tract seems to have slowed down to nearly no activity. I eat one meal a day and small healthy snacks for breakfast and dinner. Never a sound from my stomach. Have been sick for 16 years. Never had weight issues. But now have gained about 20# and eating the least I’ve ever eaten in my life. I have no energy but make myself keep moving throughout the day. No balance. Constant headaches and joint/spine pains. Can’t bare the sunlight and neck constantly hurts. Each day I feel sick. It’s a hard hard life. It’s why I live alone and will stay alone as others don’t understand and it wears me out to try to keep up or explain. Best wishes to you in this horrible journey.
After receiving 3 vaccinations surrounding 1995-96 LD clinical trial studies, I learned how far back my Lyme symptoms went. I went thru legal counsel for damages.. I went to NIH & stood before 33 gov. doctors & that vaccines results on our bodies was enough to take it off the market! But mid way through the case the pharmaceutical company SmithKlineBeecham was bought out by GlaxoSmithKline & the new owners had no vaccine records “they could find”. Its all about $$ folks. Just ask Dr.Donta retired chief of Infectious disease at BU Boston. Ive been living/struggling with these EXACT.. symptoms for decades! I could write a book.. but not without help anymore.. best to all who have been harmed by denial of LD & the epidemic it truly is
I have had RMSF and I have alpha gal syndrome . I’ve been diagnosed with Costochondritis and sleep apnea . Now I wonder if the RMSF has caused this . I was never treated for it and suffered for a very long time lost my vision for a period of time and would run intermittent 105 fevers . But this chest pressure never goes away . Have had my heart checked and lungs and they are fine . ( so they say ) but the pressure is still there … I was tested over 12 times for Lyme all negative . It took me 7.5 years to get a correct diagnoses of Aloha Gal syndrome and another 6 months for me to go back and look at actual testing for what I thought was a full Tickborne Disease panel … only to find out it was just for Lyme !!! Anyway they ruled everything out and gave me the costochronditis diagnoses . Is there a test to see about this diaphragm paralysis ?
I have Lyme disease patients who have evidence of a tick bite but never test positive for Lyme disease.
I’ve had unilateral then 6 mo later bilateral denervation of Phrenic nerves now 3+ yrs with significant loss PFT’s due to paralysis hemidiaphragms. Ideology unknown. Tested negative for Lyme disease tested once. Have had prior ticks and anaphylactic reaction to white moth caterpillar. Dx Phrenic nerve palsies/Parsonage Turner Syndrome. Did have beck and shoulder pain initially. Any advice or resources appreciated! Thx
I don’t have the experience to help you. Sorry
Dear Dr. Crameron, Thank you for replying. Do you possibly know of anyone with experience in this area? Thank you!
where is your area?