Non-Surgical Resolution of Cerebrospinal Fluid Fistula Caused by Nasal Swab for COVID-19 Diagnosis. A Case Report
DOI:
https://doi.org/10.17533/udea.iatreia.237Keywords:
COVID-19 Serological Testing, Cerebrospinal Fluid, RhinorrheaAbstract
Nasal swab tests have been extensively utilized for the diagnosis and prevention of the spread of pandemic coronavirus infection (COVID-19). Although deemed a safe and well-tolerated procedure, serious complications have been reported in its administration. This paper presents the case of a 36-year-old patient who experienced continuous watery rhinorrhea from the right nostril five days following a COVID-19 nasal swab. A diagnostic suspicion of cerebrospinal fluid (CSF) fistula was established six weeks after the onset of rhinorrhea, which was initially misinterpreted as allergic rhinitis. Rhinoendoscopic and radiological findings failed to conclusively identify a fistulous defect at the skull base, but the detection of β-2 transferrin in the nasal fluid confirmed the presence of CSF. Following medical treatment, the CSF rhinorrhea progressively decreased until resolution, with no recurrence over a one-year follow-up period. Nasal swab tests for COVID-19, while considered safe, are not without risks. The reported case demonstrated a severe intracranial injury that, despite late diagnosis, was manageable with the implemented medical treatment.
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(1) Sullivan CB, Schwalje AT, Jensen M, Li L, Dlouhy BJ, Greenlee JD, et al. Cerebrospinal Fluid Leak After Nasal Swab Testing for Coronavirus Disease 2019. JAMA Otolaryngol Head Neck Surg [Internet]. 2020;146(12):1179-81. https://doi.org/10.1001/jamaoto.2020.3579
(2) Holmes A, Allen B. Case report: An intracranial complication of COVID-19 nasopharyngeal swab. Clin Pract Cases Emerg Med [Internet]. 2021;5(3):341-44. https://doi.org/10.5811/cpcem.2021.5.52232
(3) Mistry S, Walker W, Earnshaw J, Cervin A. COVID‐19 swab-related skull base injury. Med J [Internet]. 2021;214(10):457-59. https://doi.org/10.5694/mja2.51082
(4) Knížek Z, Michálek R, Vodicka J, Zdobinská P. Cribriform plate injury after nasal swab testing for COVID-19. JAMA Otolaryngol Head Neck Surg [Internet]. 2021;147(10): 915-17. https://doi.org/10.1001/jamaoto.2021.2216
(5) Paquin R, Ryan L, Vale FL, Rutkowski M, Byrd JK. CSF leak after covid-19 nasopharyngeal swab: a case report. Laryngoscope [Internet]. 2021;131(9):1927-29. https://doi.org/10.1002/lary.29462
(6) Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun [Internet]. 2020;87:18-22. https://doi.org/10.1016/j.bbi.2020.03.031
(7) Föh B, Borsche M, Balck A, Taube S, Rupp J, Klein C, et al. Complications of nasal and pharyngeal swabs: a relevant challenge of the COVID-19 pandemic? Eur Respir J [Internet]. 2021;57(4):2004004. https://doi.org/10.1183/13993003.04004-2020
(8) Gómez M, Oliva C, Montoya F, Rojas D, Zemelman JL. Fístula de líquido cefalorraquídeo después de hisopado nasofaríngeo en pandemia COVID-19. A propósito de dos casos. Rev Otorrinolaringol Cir Cabeza Cuello [Internet]. 2021;81(2):206-210. http://dx.doi.org/10.4067/s0718-48162021000200206
(9) Alberola-Amores FJ, Valdeolivas-Urbelz E, Torregrosa-Ortiz M, Álvarez-Sauco M, Alom-Poveda J. Meningitis due to cerebrospinal fluid leak after nasal swab testing for COVID-19. Eur J Neurol [Internet]. 2021 Nov;28(11):e91-e92. https://doi.org/10.1111/ene.14736
(10) Keros P. On the practical value of differences in the level of the lamina cribrosa of the ethmoid. Z Laryngol Rhinol Otol [Internet]. 1962;41:809-13. Disponible en: https://pubmed.ncbi.nlm.nih.gov/14032071/
(11) Perneczky J, Neuchrist C, Sellner J. Rhinorrhea following SARS-CoV-2 nasopharyngeal swab: A case for β2-transferrin testing. Eur J Neurol [Internet]. 2021 Nov;28(11):3552-53. https://doi.org/10.1111/ene.14883
(12) Martínez MM, Miranda E, Bosco G, García R, Pardo A, Arenas O, et al. Fístula traumática de líquido cefalorraquídeo tras realización de test PCR mediante hisopo nasal para el diagnóstico de COVID-19. Revisión sistemática. Rev ORL [Internet]. 2022;13(1):71-9. https://doi.org/10.14201/orl.27912
(13) Mourad M, Inman JC, Chan DM, Ducic Y. Contemporary trends in the management of post-traumatic cerebrospinal fluid leaks. Craniomaxillofac Trauma Reconstr [Internet]. 2018;11(1):71–77. https://doi.org/10.1055/s-0036-1584890
(14) Rajah J, Lee J. CSF rhinorrhea post COVID-19 swab: A case report and review of literature. J Clin Neurosci [Internet]. 2021;86:6-9. https://doi.org/10.1016/j.jocn.2021.01.003
(15) Lobo BC, Baumanis MM, Nelson RF. Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: a systematic review. Laryngoscope Investig Otolaryngol [Internet]. 2017;2(5):215–224. https://doi.org/10.1002/lio2.75
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