CSF rhinorrhea after nasopharyngeal swab testing for COVID-19: A case report and review of literature

Abstract

Background There are more than 206 million confirmed cases of Covid-19 infection globally. Nasopharyngeal swab testing is one of the widely used diagnostic methods for the initial diagnosis of such cases. With the growing diagnostic testing capacity, it is expected to observe an increased number of adverse events due to nasopharyngeal testing. Clinical presentation A middle-aged woman presented with unilateral rhinorrhea, started after nasopharyngeal swab test for Covid-19. She had no prior medical issues. Thorough examination and imaging showed the presence of cerebrospinal fluid leakage. Conclusion Nasopharyngeal swab testing may lead to serious complications and taking a brief history might be helpful. Also, patients should be educated on different complications of nasopharyngeal swab testing and their associated symptoms.

Complications of Nasopharyngeal Swabs and Safe Procedures for COVID-19 Testing Based on Anatomical Knowledge

“…Finally, 27 articles were selected for review. 3 11 12 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 40 41 …”

“…Retained swabs 3 12 16 17 18 20 21 24 26 27 32 35 due to swab fracture during the examination and epistaxis 3 12 17 24 28 32 were the frequently reported complications. Cerebrospinal fluid (CSF) leakage 3 11 12 15 22 23 28 29 30 33 34 36 was a frequently documented serious adverse event requiring prompt attention and evaluation. Nasal septal abscess, 3 12 17 19 25 and ethmoidal silent syndrome 31 were also reported as related complications after nasopharyngeal swabbing.…”

“…It is commonly thought to be rare, but severe cases have been reportedly related to nasopharyngeal COVID-19 testing. 11 15 22 23 28 29 30 33 34 36 Traumatic CSF leakage after nasopharyngeal COVID-19 testing is usually manifested as unilateral clear rhinorrhea, persistent headache, or salty or metallic taste postnasal drip within 48 hours after the procedure. 11 22 29 30 33 34 36 The amount of rhinorrhea tends to increase with bending forward and Valsalva maneuver.…”

“… 11 15 22 23 28 29 30 33 34 36 Traumatic CSF leakage after nasopharyngeal COVID-19 testing is usually manifested as unilateral clear rhinorrhea, persistent headache, or salty or metallic taste postnasal drip within 48 hours after the procedure. 11 22 29 30 33 34 36 The amount of rhinorrhea tends to increase with bending forward and Valsalva maneuver. 11 22 29 30 The majority of CSF leakage originated from damage in the cribriform plate ( Fig.…”

“…However, numerous complications, from minor to even fatal ones, have been repetitively reported in the media 13 14 and literatures 3 11 12 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 although complications required further medical evaluation were rarely happened ranging from 0.0012% 24 to 0.026%. 20 In addition, excessive quarantine burden and stressful condition of the COVID-19 pandemic 37 38 occasionally causes uncomfortable testing by the examiner who may not fully understand the nasopharyngeal anatomy or clinically cautious events related to nasopharyngeal swabs.…”