Case report	Sequence of symptoms	CSF studies	Diagnosis of lyme disease	Time of diagnosis of phrenic nerve palsy	Antimicrobial administered	Follow up evaluation of dyspnea
1 (Melet et al. – 1987) [1]	Fever, left facial paralysis	Lymphocytic pleocytosis 225 cells	Serum Borrelia burgdorferi antibody rising titer	With the presentation	Ampicillin and netilmicin	Expired 3 months later from pulmonary embolism
2 (Faul et al. - 1998) [2]	Skin rash 6 weeks prior, presenting with left facial weakness, right shoulder and bilateral knee pain, mild dyspnea	Not done	Serum Borrelia burgdorferi IgM and IgG antibodies positive	With the presentation	Doxycycline 3 weeks	Symptom-free 1 year later
3 (Winterholler et al. - 2001) [3]	Dyspnea and cervical pain	44 cells per cubic millimeter, 70 % lymphocytes, several plasma cells, 20 % monocytes and 10 % granulocytes, protein 1130 g/L, positive oligoclonal bands	Serum Borrelia burgdorferi IgG titer 1:160, CSF Borrelia burgdorferi IgG titer 1:64	With the presentation	Ceftriaxone 2 courses, doxycycline 1 course	Chronic tracheostomy required
4 (Ishaq et al.- 2002) [4]	Skin rash 3 months prior, facial palsy 1 week ago later, presenting with neck/back pain and dyspnea	White blood cell count 541/mm³ with 99 % lymphocytes, glucose 40 mg/dL, protein 271 mg/dL	CSF Borrelia burgdorferi PCR was negative, serum Borrelia burgdorferi IgG was positive and IgM was equivocal	With the presentation	Ceftriaxone 3 weeks	Significant improvement 3 weeks later
5 (Gomez et al. - 2003) [5]	Known tick bite, lower extremity pain, dyspnea	Not done	Serum Borrelia burgdorferi IgM antibody positive	With the presentation	Doxycycline 1 month	No improvement 6 months later
6 (Abbott et al. - 2004) [6]	Right leg weakness, abdominal distention, constipation followed by dyspnea on day 3 of hospitalization; tick mouthparts recovered from upper abdomen	White blood cell count 181/mm³ (100 % mononuclear), red blood cell count 22/mm³, glucose 2.3 mmol/L, protein 0.96 g/L	Serum Borrelia burgdorferi IgM and IgG antibodies positive	With the presentation	Ceftriaxone 4 weeks	Persistence with moderate improvement 1 year later
7 (van Egmond et al. – 2010) [7]	Headache, dyspnea, diplopia	Lymphocytic pleocytosis 186 × 106/L mononuclear cells, glucose 3.6 mmol/L, protein 0.62 g/L	Serum and CSF Borrelia burgdorferi IgM antibody positive, CSF Borrelia burgdorferi PCR negative	With the presentation	Ceftriaxone 3 weeks	Complete resolution 2 years later
8 (van Egmond et al. – 2010) [7]	Dyspnea, followed by radiculopathic pain in arms and right leg 3 months later, and then hospitalization with severe dyspnea	Lymphocytic pleocytosis	Serum and CSF Borrelia burgdorferi IgM and IgG antibodies positive	With the hospitalization	Doxycycline 2 weeks as outpatient, followed by ceftriaxone 4 weeks	Persistence with mild improvement 2 years later
9 (van Egmond et al. – 2010) [7]	Bilateral thoracic shooting pain, dyspnea	Patient refused lumbar puncture	Serum Borrelia burgdorferi IgG antibody positive	With the presentation	Ceftriaxone 2 weeks	No improvement 2 years later
10 (Torgovnick et al. - 2010) [8]	Noted paralysis of right hemidiaphragm on preoperative evaluation	Not done	Serum Borrelia burgdorferi IgG positive	With the presentation	Doxycycline, duration unknown	Lost to follow-up
11 (Petrun et al. - 2013) [9]	Left lumboischialgia, obstipation, followed by dyspnea 2 weeks into hospitalization, reduced left ventricular ejection fraction 35 %	Leukocyte count 228/mL with lymphocyte predominance 205/mL	CSF Borrelia PCR was negative, CSF and serum IgG antibody for Borrelia burgdorferi 1:1.024 and 1:1.024, respectively and negative IgM antibodies	2 weeks into hospitalization	Ceftriaxone 3 weeks	Persistence with moderate improvement 3 months later.
12 (Djukic et al. - 2013) [10]	Headache, shooting left-sided thoracic pain, fatigue followed by dyspnea after discharge	Lymphocytic pleocytosis 129 cells per microliter, protein 1324 mg/L	CSF Borrelia burgdorferi-specific antibody index for IgG 5.0 and for IgM 0.8, negative CSF PCR	2 days after 2 weeks of ceftriaxone	2 weeks of ceftriaxone, followed by 2 weeks of oral doxycycline	Persistence with moderate improvement 6 months later
13 (Basunaid et al. - 2014) [11]	Skin rash followed by low-grade fever, arthralgia and nocturnal hypoventilation	Not done	Serum Borrelia burgdorferi IgG antibody positive	With the presentation	Doxycycline 4 weeks	Resolution, duration of follow-up not reported
14 (Reddy et al. - 2015) [12]	Headache, arthralgia, followed by right facial palsy and dyspnea on exertion	Total nucleated cells 2/mm³ (52 % lymphocytes), glucose 64 mg/dL, total protein 47 mg/dL	Serum Borrelia burgdorferi IgM and IgG antibodies positive	14 weeks after antimicrobial therapy	Ceftriaxone 4 weeks	Persistence with moderate improvement 9 months later
15 (Bon et al. – 2019) [13]	Tick bite, skin rash, treated with doxycycline, then dyspnea requiring hospitalization	0 elements, 11 red cells, protein level 0.42 g/L (normal less than 0.40 g/L), glucose 4.37 mmol/L (normal between 2-4 mmol/L)	Serum and CSF Borrelia burgdorferi IgM and IgG antibodies positive	With the hospitalization	Ceftriaxone 3 weeks	Complete resolution 1 year later
16 (our case)	Skin rash followed by dyspnea	Not done	Serum Borrelia burgdorferi IgM antibody positive	With the presentation	Ceftriaxone 3 weeks	Complete resolution 12 months later