My husband age 52, non smoker and in good health became ill 2 1/2
months ago. He had severe muscle pain of both arms, hands and inner right leg followed by numbness of those areas. All test were negative except for MRI showing some inflamation of the brain. Shortness of breath was noted about 2 months ago. Chest xray shows atelectesis of the right lobe. Diaphragm is elevated on the right side. CTof chest shows atelectasis/infiltrate in the right middle and lower lobe. No mass or disease. Lungs are clear with no effusion.CT of the abdomen is negative. Pulmonologist suggest broncoscopy to check for tumors or infection. He did have a herpes sore on his lip when this illness started can herpes cause these symptoms? Please advise what test are indicated at this point. Is broncoscopy needed?
The pulmonologist started him on Levoquin. Please point us in the right direction!!!!
Many diagnoses could account for the signs and symptoms you described, but they are suggestive of Lyme Disease. Although pulmonary involvement in Lyme Disease is uncommon, about 15% of patients develop significant neurologic signs and a majority experience muscle and/or joint pain.
Elevation of the diaphragm may occur because of diaphragmatic paralysis, atelectasis (collapse) of the lower part of the lung, or secondary to fluid in the abdominal cavity (ascites). It appears that abdominal fluid has been ruled-out by the CT scan. Fluid in the pleural space can sometimes gather between the lung and the diaphragm giving the appearance, on X-ray, of an elevated diaphragm. This too seems to have been ruled out by the CT Scan.
It would be important to determine if the diaphragm is paralyzed or has moved to a high position because of the lung atelectasis (collapse). This could be checked with fluoroscopy. If the diaphragm is still capable of movement, the elevation might be secondary to the lung atelectasis. In either event bronchoscopy is definitely indicated and should be the next step.
The herpes infection described is probably unrelated to all that has occurred.
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