The neuroinvasive and neurotropic potential of coronaviruses has been well documented and described in the literature.1,2 Additionally, many studies have described the neurologic manifestations and subsequent complications associated with SARs-CoV-2infection. These include olfactory and gustatory symptoms along with Guillain Barre syndrome, Bell’s Palsy, and encephalopathy, as well as cranial and peripheral neuropathies.3–5 However, there are only two reports of phrenic nerve paralysis following COVID-19 infection. In one report, the patient had baseline characteristics similar to the patient described in this report. He was also intubated for a significant period of time; however, he was never proned and ultimately required tracheostomy. He also developed unilateral, right hemidiaphragm paralysis, although this was discovered relatively early on in his disease course.6 Another report out of France describes a patient who presented with respiratory distress preceded by anosmia and dysgeusia but was without lung injury on CT scans. She was ultimately found to have PCR positive COVID-19 and x-rays demonstrated minimal movement of the diaphragms bilaterally during respiration.7 There are limitations to this report, such as no chest radiograph immediately prior to his hospitalization, which would be unexpected in someone without symptoms.
Although prolonged intubation and mechanical ventilation can be associated with diaphragm weakness and paralysis, an increasing number of studies are demonstrating the SARs-CoV-2’s affinity for neural tissues resulting in peripheral nerve, muscle, and cranial nerve dysfunction. Given the rarity of such neuromuscular complications, these reports are crucial for understanding the neuropathogenicity of the virus which is still under research. Additionally, these reports highlight the importance of thorough diagnostic testing and the consideration of diaphragm paralysis in patients with ongoing respiratory dysfunction after covid infection.