Resolution of Pulmonary Inflammation and Obstruction Following Repair of Cerebrospinal Fluid Leak: A Case Report and Review of the Literature

TL;DR

A patient's lung issues improved after fixing a cerebrospinal fluid leak, suggesting a rare link between CSF leaks and lung inflammation.

Contribution

This case report highlights a rare connection between CSF leaks and pulmonary symptoms, emphasizing the importance of considering CSF rhinorrhea in unexplained lung conditions.

Findings

Pulmonary inflammation and obstruction resolved after surgical repair of a CSF leak.

Chest CT showed resolution of ground-glass opacities following surgery.

Clinical improvement in symptoms like cough was observed post-surgery.

Abstract

Cerebrospinal fluid (CSF) rhinorrhea involves drainage of CSF through the nasal cavity due to disruption of the skull base, and pneumonitis secondary to CSF aspiration is a lesser‐known complication reported. We present the case of a patient whose pulmonary symptoms and function improved after surgical CSF leak repair.

This is a case report with review of the electronic medical record and literature review.

A 35‐year‐old female presented with 1 year of refractory right‐sided rhinorrhea and recurrent lower respiratory infections. Nasal drainage was positive for beta‐2‐transferrin. Sinus CT showed a possible leakage site at the right lateral lamella of the cribriform plate. Chest CT showed upper lobe predominant ground‐glass opacities. Following surgical CSF leak repair, chest CT showed resolution of ground‐glass opacities and pulmonary function testing showed an increase in spirometric lung volumes.

Aspiration pneumonitis from CSF leaks is rarely reported. Studies report resolution of ground‐glass opacities on chest CT as well as clinical improvement in symptoms such as cough following surgical leak repair. Proposed mechanisms leading to aspiration pneumonitis include nasopharyngeal bacterial transit; the mechanism of persistent leak may be related to cough‐induced increase in intracranial pressure leading to increased CSF flow. In patients with lower airway inflammation and obstruction as well as unexplained aspiration pneumonitis, a high index of suspicion for CSF rhinorrhea is warranted.

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