Abstract
Borrelia burgdorferi is a spirochete that can cause Lyme disease from an infected tick bite causing a myriad of syndromes ranging from erythema migrans to oligoarticular arthritis and/or atrioventricular conduction block in the heart. It can also infect the central nervous system (CNS) and peripheral nervous system (PNS) causing cranial neuropathy, radiculoneuropathy as well as myelopathy. It has rarely been reported to involve the phrenic nerve presenting as dyspnea from diaphragmatic paralysis. Here, we present a case of a patient presenting with orthopnea and dyspnea on exertion who was diagnosed with Lyme disease causing unilateral diaphragmatic paralysis with resolution after treatment.