First Case of Cerebrospinal Fluid Leak After Nasal Swab Test
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Testing for presence of active SARS-CoV-2 infection is 1 pillar of the global response. In particular, nasopharyngeal, anterior nasal, and midturbinate swabs are 3 of the 5 methods for initial diagnostic specimen collection recommended by the CDC. However, complications associated with nasal swab testing are not well characterized. We describe the first case of a CSF leak after nasal testing for COVID-19.

A woman in her 40s presented with unilateral rhinorrhea, metallic taste, headache, neck stiffness, and photophobia. The patient had recently completed nasal COVID-19 testing for an elective hernia repair. Shortly after, she developed unilateral rhinorrhea, headache, and vomiting. The patient’s medical history was notable for idiopathic intracranial hypertension and removal of nasal polyps over 20 years before presentation. Physical examination revealed clear rhinorrhea from the right side.

Flexible nasopharyngoscopy revealed a mass in the right anterior middle meatus, but did not identify the source of the fluid. The nasal drainage tested positive for Beta 2-transferrin. CT and MRI identified a 1.8-cm encephalocele extending through the right ethmoid fovea into the middle meatus and a right sphenoid wing pseudomeningocele. Comparing these images to findings on CT performed in 2017 revealed that the encephalocele dated at least to that time. The 2017 CT diagnosis was paranasal sinus disease but not an encephalocele.

The patient was admitted to the hospital for endoscopic surgical repair. At the beginning of the procedure, intrathecal fluorescein was infused through a lumbar drain. An encephalocele was identified in the right anterior ethmoid cavity. After reduction of the encephalocele, a skull base defect in the fovea ethmoidalis was repaired with a combination of acellular human dermal matrix and a poly(D,L-lactic) acid. The patient was admitted postoperatively for neurological monitoring and lumbar drain management.

Source: https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2771362
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