Abstract
Background. Brachial neuritis (BN) is a rare inflammatory condition of peripheral nerves, usually involving the cervicobrachial plexus. These patients present with sudden onset of shoulder and arm pain that evolves into muscle weakness and atrophy.. Case Report. A 33-year-old woman presented with a 1-month history of diffuse pain in her thorax. She had no trauma or inciting incident prior to the onset of this pain and was initially treated for muscle spasms. The patient was seen in the emergency room multiple times and was treated with several courses of antibiotics for pneumonia on the basis of clinical symptoms and abnormal x-rays. The pleuritic chest pain persisted for at least 4 months, and the patient was eventually admitted for worsening pain and dyspnea. On physical examination, crackles were heard at both lung bases, and chest inspection revealed increased expansion in the upper thorax but poor expansion of the lower thorax and mild paradoxical respiration. “Sniff” test revealed no motion of the left hemidiaphragm and reduced motion on the right hemidiaphragm. Her computed tomography scan revealed bilateral atelectasis, more severe at the left base. She reported no symptoms involving her joints or skin or abdomen. Her presentation and clinical course are best explained by BN with a bilateral diaphragmatic weakness. However, she had a positive ANA, RF, anti-RNP antibody, and anti SS-A. Conclusion. Patients with BN can present with diffuse thoracic pain, pleuritic chest pain, and diaphragmatic weakness. Our patient may represent a case of connective tissue disease presenting with brachial plexus neuritis.
Highlights
Brachial neuritis (BN) or neuralgic amyotrophy, or Parsonage-Turner syndrome, is a rare idiopathic neuropathy that can present with a variety of lower motor neuron symptoms
We report a patient with persistent pleuritic pain, bilateral phrenic nerve weakness, and atelectasis secondary to BN who had positive serological tests for connective tissue disease
Pulmonary function tests done 2 months after the initial hospitalization revealed a forced expiratory volume in 1 second (FEV ) 1.4 L (43.9% predicted), forced vital capacity (FVC) 1.9 L (47.3% predicted), forced expiratory volume in second (FEV) /FVC ratio 0.77, total lung capacity 3.7 (60.8% predicted), a normal residual volume 1.7 L (105.2% predicted), and a severely reduced diffusing capacity for carbon monoxide (36.4% predicted) that partially corrected with adjustment for alveolar volume (67.7% predicted)
Summary
Brachial neuritis (BN) or neuralgic amyotrophy, or Parsonage-Turner syndrome, is a rare idiopathic neuropathy that can present with a variety of lower motor neuron symptoms. Our patient is a 33-year-old African American woman with a past history of hypertension and hypothyroidism who had repeated emergency room visits for pleuritic chest pain and dyspnea. A fluoroscopic “sniff” test showed no movement of the left diaphragm and reduced movement on the right, consistent with bilateral phrenic nerve involvement and respiratory muscle weakness She was subsequently prescribed muscle relaxants, pulmonary hygiene with a vibratory therapy system, incentive spirometry, and pain medication, including indomethacin for symptomatic relief. Two months later the patient described her chest pain as markedly improved compared to her first admission She reported her pain at rest as 3/10, mild in intensity, in the lower part of her rib cage but nonradiating, and aggravated with daily routine activities. Skeletal x-rays done 6 months after her initial presentation with chest pain showed no evidence of rheumatoid arthritis
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