Arnold-Chiari Malformation and Scoliosis: A Chronic Lung Collapse Mimicking Sepsis

Abstract

Scoliosis is a deformity of the spine caused by excessive lateral curvature. Compared to other variants, neuromuscular scoliosis is more likely to progress, altering the body's normal architecture in a relatively short period of time. Furthermore, patients with Arnold-Chiari malformation or Chiari malformation (CM) type 2 have intrinsic neurological complications that might entangle the initial clinical assessment. A 24-year-old woman with a history of scoliosis and CM type 2 status post-tracheostomy was admitted from a skilled nursing facility after a one-day history of low blood pressure, leukocytosis, and an outpatient chest X-ray suspicious for pneumonia. Physical examination was remarkable for hypotension and decreased breath sounds at the left pulmonary base. A tracheostomy tube and central venous catheter were noticed. Initial laboratory results revealed leukocytosis with borderline bandemia and a chest X-ray with a left lower lung consolidation. She was treated as a case of sepsis, for which broad-spectrum antibiotics were immediately started. However, upon review of charts, the patient's objective findings were similar to a previous admission. Chest computed tomography scan revealed atelectasis in the left lower lung with no signs of consolidation, effusions, or abscesses. After extensive workup, no identifiable cause was found to suggest an acute process. Antibiotic therapy was halted and the patient was discharged to her nursing home. This case presents a patient with CM type 2 and scoliosis complicated by chronic and worsening atelectasis. Accurate initial assessment and communication between providers are paramount to avoid overtreatment.