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A rash and a rare cause of unilateral diaphragmatic paralysis.

Abstract 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.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title bmj case reports
Publication Year Start




PMID- 28249882
OWN - NLM
STAT- MEDLINE
DA  - 20170302
DCOM- 20170314
LR  - 20170314
IS  - 1757-790X (Electronic)
IS  - 1757-790X (Linking)
VI  - 2017
DP  - 2017 Mar 01
TI  - A rash and a rare cause of unilateral diaphragmatic paralysis.
LID - bcr2016218440 [pii]
LID - 10.1136/bcr-2016-218440 [doi]
AB  - 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.
CI  - 2017 BMJ Publishing Group Ltd.
FAU - Ashkir, Zakariye M
AU  - Ashkir ZM
AD  - University Hospitals of Leicester NHS Trust, Leicester, UK.
AD  - Northampton General Hospital NHS Trust, Northampton, UK.
FAU - Tsaknis, George
AU  - Tsaknis G
AD  - University Hospitals of Leicester NHS Trust, Leicester, UK.
AD  - Northampton General Hospital NHS Trust, Northampton, UK.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20170301
PL  - England
TA  - BMJ Case Rep
JT  - BMJ case reports
JID - 101526291
RN  - 1806D8D52K (Amitriptyline)
RN  - X4HES1O11F (Acyclovir)
SB  - IM
MH  - Acyclovir/administration & dosage
MH  - Amitriptyline/administration & dosage
MH  - Diaphragm/*physiology
MH  - Exanthema/*etiology
MH  - Herpes Zoster/*drug therapy/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neuralgia/drug therapy
MH  - Respiratory Paralysis/*diagnosis/etiology/virology
MH  - Treatment Outcome
EDAT- 2017/03/03 06:00
MHDA- 2017/03/16 06:00
CRDT- 2017/03/03 06:00
AID - bcr-2016-218440 [pii]
AID - 10.1136/bcr-2016-218440 [doi]
PST - epublish
SO  - BMJ Case Rep. 2017 Mar 1;2017. pii: bcr2016218440. doi: 10.1136/bcr-2016-218440.

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