A case of recurrent pneumonia due to Arnold Chiari malformation

Abstract

Chiari malformation was defined herniation of the cerebellar tonsils through the foramen magnum into the cervical spinal canal. Bilateral vocal cord paralysis has been reported as a result of Chiari malformation, but is rare. We describe 37-year-old male patient with recurrent lower respiratory tract infection during last year. The patient had decompression surgery due to Arnold Chiari Type 1 malformation, 5 years earlier. One year ago, he was hospitalized with aspiration pneumonia. He admitted to our deparment for further evaluation because of previous hospitalization twice within 5 months. Thoracic CT showed bilateral ground glass opacities and acinary infiltration. Aspergillus flavus growth in bronchoalveolar lavage culture samples. Lung biopsy was performed and postoperative fourth day, patient had respiratory distress and stridor. Bilateral vocal cord paralysis was observed with endoscopic examination and emergency tracheostomy was performed. During follow up,patient complained headache and numbness in his hands and feet. The extent of tonsillar herniation below the foramen magnum was determined to be 9 mm by MRI. Neurosurgical team was consulted and the patient underwent a posterior fossa decompression and fascia lata duraplasty. Pulmonary infiltrates resolved after appropriate therapy. Right lower lobe wedge biopsy material was compatible with foreign body in bronchioles. Recurrent pneumonia episodes were secondary to Arnold Chiari type 1 malformation in consequence of micro-macro aspirations during a year. We report a rare case of Chiari malformation which presented to the pulmonology department with bilateral vocal cord paralysis following an aspiration pneumonia.