Wasey Ali Yadullahi Mir, MD
Chief Resident Internal Medicine
Mount Sinai Hospital Chicago Medical Center, Illinois
Disclosure information not submitted.
Hassan Hashm
Pulmonary Disease Fellow
Rosalind Franklin University of Medicine and Science
Wadsworth, Illinois
Disclosure information not submitted.
Lavanya Srinivasan, MD, FCCP
Pulmonary and Critical Care Medicine Physician
Rosalind Franklin University of Medicine and Science, United States
Disclosure information not submitted.
Title: Unilateral Diaphragmatic Paralysis Secondary to COVID-19
Introduction: The various long-term complications from COVID-19 infections are beginning to emerge. At this time, it is difficult to predict which patients will suffer from long-term effects and what symptoms will develop or persist. As seen in other viral infections - such as herpes zoster, HIV, and Zika - unilateral diaphragmatic paralysis may also be linked to COVID-19.
Description: A 54-year-old male was referred to our clinic to evaluate shortness of breath that began after his diagnosis of COVID-19 four months prior. He was treated with bamlanivimab and did not require hospitalization. He was unable to walk more than one block due to dyspnea. His past medical history included diabetes mellitus, hypertension, and hyperlipidemia. His medications consisted of aspirin, metformin, irbesartan, and simvastatin. The patient was a former tobacco smoker with a two-pack-year history. He denied any respiratory issues before his COVID-19 diagnosis, and his only surgical history was for a calcaneal spur excision. His prior chest imaging was unremarkable. A CT scan of the chest revealed an elevated right hemidiaphragm, a solitary sub-centimeter pulmonary nodule. The patient subsequently underwent a sniff test via chest fluoroscopy that revealed paradoxical motion of the right hemidiaphragm and normal excursion of the left hemidiaphragm. Pulmonary function testing was unremarkable. A diagnosis of unilateral diaphragmatic paralysis was made. The patient decided on conservative therapy instead of surgical intervention, and his dyspnea improved upon follow-up.
Discussion: Unilateral diaphragmatic paralysis is emerging as a complication of COVID-19 in the acute and chronic stages. Theories regarding the pathophysiology of this condition include neurotropism, autoimmunity, and microvascular damage. While current publications highlight the importance of this condition in mechanically ventilated patients, our case demonstrates that unilateral diaphragmatic paralysis can occur in COVID-19 patients in the outpatient setting who were also treated with bamlanivimab.