Abstract Introduction Coronavirus disease (COVID-19), caused by the SARS-CoV-2 virus, led to the 2019 global pandemic. While it primarily affects the lower respiratory tract, it is increasingly recognized to cause extrapulmonary sequelae that can last months to years, collectively termed Post-COVID Syndrome. Further studies are needed to clarify these long-term complications. Common manifestations include anosmia, dysgeusia, chronic cough, and dyspnea; however, new presentations continue to emerge, significantly impairing quality of life. Case Discussion An 81-year-old Puerto Rican male with a 20-pack-year smoking history presented to the outpatient clinic with progressive exertional dyspnea after a COVID-19 infection in May 2023. He reported no prior respiratory limitations. Albuterol provided only partial relief. He denied fever, weight loss, dysphagia, hemoptysis, pleuritic pain, trauma, or recent surgery. On examination, he was in no acute distress, but percussion and auscultation revealed absent right diaphragmatic excursion. Chest X-ray and CT demonstrated new right hemidiaphragm elevation. A sniff test confirmed a lack of excursion, consistent with phrenic nerve paralysis. Baseline spirometry test revealed an obstructive pattern with possible restriction due to decreased FEV1/FVC and FVC. Gabapentin 300 mg daily was initiated for suspected neuropathic diaphragmatic dysfunction. After 3 months, the patient reported marked improvement in exertional tolerance. Repeat spirometry showed an FEV1 increase of 330 mL and an FVC increase of 200 mL, with an FEV1/FVC ratio of 78, confirming resolution of the obstruction. Overall, lung function improved from moderate to severe mixed physiology to isolated moderate restriction. Flow-volume loops normalized, and examination confirmed improved diaphragmatic excursion. Discussion Dyspnea is the most persistent symptom of Post-COVID Syndrome, but not always due to fibrosis or airway disease. In this case, abnormal imaging revealed unilateral diaphragmatic paralysis from phrenic nerve dysfunction, leading to restrictive physiology. Treatment with gabapentin was associated with both symptomatic and spirometric recovery, suggesting a potential role for neuromodulatory therapy in post-viral diaphragmatic dysfunction. This abstract is funded by: None
Valentin et al. (Fri,) studied this question.