Unilateral or bilateral raised hemidiaphragms were observed on chest X-ray in three patients with severe tetanus. Diaphragmatic movement was absent on ultrasonography and fluoroscopy. Nerve conduction study confirmed phrenic nerve palsy. Bilateral involvement caused delayed weaning from the ventilator, whereas unilateral involvement was asymptomatic. There was complete recovery from phrenic nerve palsy in all patients.

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Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organ systems. Clinical presentation of SLE can be heterogeneous, and diagnosis may be difficult at times. Skin is commonly involved in SLE, and cutaneous manifestations often provide a clue to underlying lupus in affected individuals. Cutaneous manifestations of SLE include malar rash, discoid rash, and hair loss. Vesicobullous lesions are observed in up to 5% of patients with SLE. 1 However, toxic epidermal necrolysis (TEN)-like lesions are rarely described in the literature. Available reports suggest that TEN in patients with lupus is usually related to drugs. Epidermal necrolysis as a presenting manifestation of lupus is a very rare occurrence.

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