Bilateral diaphragmatic dysfunction: A cause of persistent dyspnea in patients with post-acute sequelae of SARS-CoV-2

Christine Gill; Alpana Garg; Rami Fakih; Nabeel Y Hamzeh

doi:10.1177/2050313X221105990

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Bilateral diaphragmatic dysfunction: A cause of persistent dyspnea in patients with post-acute sequelae of SARS-CoV-2

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Bilateral diaphragmatic dysfunction: A cause of persistent dyspnea in patients with post-acute sequelae of SARS-CoV-2

Christine Gill, Alpana Garg, Rami Fakih and Nabeel Y Hamzeh

SAGE open medical case reports, Vol.10, p.2050313

01/2022

DOI: 10.1177/2050313X221105990

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Abstract

Persistent shortness of breath is one of the most common concerns reported by patients with post-acute sequelae of SARS-CoV-2. Here, we present a case of bilateral diaphragmatic paralysis as a cause shortness of breath that developed after SARS-CoV-2 infection. A middle-aged gentleman with history of sleep apnea and body mass index 27.9 kg/m2 presented to our post-COVID clinic with 3 months of dyspnea and orthopnea after contracting SARS-CoV-2 in November 2020. During acute infection, he was hospitalized for hypoxemia, which improved with steroids and supplemental oxygen. At 3 months, he continued to report dyspnea and orthopnea. On examination, he had tachycardia and increased respiratory rate with paradoxical respiratory abdominal movement. Chest imaging showed elevated bilateral hemidiaphragms without any parenchymal lung disease. Pulmonary function test revealed severe ventilatory defect with restrictive lung disease. He was diagnosed with bilateral diaphragmatic dysfunction which was confirmed by absence of evoked potentials in diaphragm after phrenic nerve stimulation bilaterally. He was advised to use continuous positive airway pressure machine to assist with breathing at night. At his last follow-up (1-year post-infection), he was symptomatically improving without specific interventions.

Details

Title: Subtitle: Bilateral diaphragmatic dysfunction: A cause of persistent dyspnea in patients with post-acute sequelae of SARS-CoV-2
Creators: Christine Gill - University of Iowa
Alpana Garg - Division of General Internal Medicine, Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
Rami Fakih - Department of Neurology, The University of Iowa, Iowa City, IA, USA
Nabeel Y Hamzeh - University of Iowa
Resource Type: Journal article
Publication Details: SAGE open medical case reports, Vol.10, p.2050313
DOI: 10.1177/2050313X221105990
ISSN: 2050-313X
eISSN: 2050-313X
Language: English
Date published: 01/2022
Academic Unit: Neurology; Pulmonary, Critical Care, and Occupational Medicine; General Internal Medicine; Internal Medicine
Record Identifier: 9984303021002771

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