key: cord-0951409-sbqolwwd
authors: Dündar, Görkem; Özer, Serdar; Süslü, Ahmet Emre; Önerci, Metin
title: Covid-19 Nasopharyngeal Swab Related CSF Rhinorrhoea: A case report
date: 2022-03-26
journal: Indian J Otolaryngol Head Neck Surg
DOI: 10.1007/s12070-022-03096-z
sha: d6656a270e276b7b7f4b97f8ecf5feaeebdc73f0
doc_id: 951409
cord_uid: sbqolwwd

With the onset of the COVID-19 pandemic, the number of nasopharyngeal swab samples has increased significantly. In this case report, the treatment of a patient who developed unilateral rhinorrhea after nasopharyngeal swab sample is presented. It is aimed to draw attention to the fact that this complication can be prevented with the appropriate technique during nasopharyngeal swab sampling.

The Coronavirus 2019 (Covid-19) caused a pandemic which affected the whole world. Identification and isolation of asymptomatic and symptomatic individuals is crucial in taking the disease under control. Existence of diagnostic tests with high precision is also very important in this task. Taking nasopharyngeal swab samples is one of the frequently used tests accepted by the Centers for Disease Control and Prevention (CDC) [1] . However, complications during nasopharyngeal swab sample procedures have not clearly been documented. In this case presentation, the rhinorrhea of the cerebrospinal fluid (CSF) during the nasopharyngeal swab sampling and its fixation has been explained. with ESS. In the other study, a 59-year-old male patient was diagnosed with defect at the left sphenoid sinus lateral wall after CSF leakage detected from left nasal passage following nasopharyngeal swab sampling, and was repaired by vascularized nasoseptal flap under ESS. In the other patient presented in the literature, severe pain occurred following nasopharyngeal swab sampling, and rhinorrhea started immediately after sampling [5] . Paranasal CT and MRI indicated defect in cribriform plate combination location, and fovea etmoidalis in the anterior of sphenoid sinus rostrum. They were repaired by graft prepared from middle concha mucosa resected with ESS.

In the case we presented, lack of previous rhinorrhea history and emergence of the complaints of the patient after nasopharyngeal swab sampling could be related with trauma. However, both the localization of the defect and presence of symptoms regarding chronic intracranial pressure increase in patient's preoperative MRI cisternography, CSF rhinorrhea could be considered as not deriving directly from skull base trauma during nasopharyngeal swab sampling. CSF rhinorrhea could be caused by trauma of the preexisting encephalocele deriving from sphenoid sinus lateral wall.

Along with increasing vaccination efforts aiming at taking the Covid-19 pandemic, nasopharyngeal swab sampling is still an effective method in diagnosing the illness. At this point, we believe that it is highly important that nasopharyngeal swab sampling should be executed by taking into consideration of anatomical differences and patient-based factors. In order to prevent complications which might derive from nasopharyngeal swab sampling, the patients must be asked whether they had history of base of skull surgery or nasal surgery before testing. We believe that such complications are preventable with appropriate technical and anatomical knowledge.

between the defected dura and the bone. CSF rhinorrhea was seen stopped. After layered waterproof repairment by placing middle concha mucosa, the procedure was finalized without any complications. Post-operatively after being monitored for five days in hospital, the patient was given bed rest, antibiotics (ampicillin sulbactam) and anti-diuretic (acetazolamide). No CSF rhinorrhea was detected at endoscopic examination on the 14th day post-operatively. The sphenoid sinus specimens which had been sent for pathological analysis were confirmed encephalocele.

Since the emergence of the Covid-19 pandemic, a significant increase in the use of nasopharyngeal swab samples was observed. Complications such as; epistaxis after taking nasopharyngeal swab sample, swab remaining inside nasal cavity after breaking, and CSF rhinorrhea might be seen rarely during sampling. [2] . The CSF rhinorrhea happened by trauma can cause neurological sequels and vital complications because they have the risk of meningitis. For that reason, they should be repaired urgently as soon as they are diagnosed.

Two cases which have been presented in the literature as related with nasopharyngeal swab samples taken for Covid-19 diagnosis are found to be deriving from sphenoid sinus lateral wall, and indicating similarities with the case presented in our work [3, 4] . There was no CSF leakage, although there was defective area on the skull base due to increased intracranial pressure in paranasal CT taken previously, in the patient in the first study. The rhinorrhea was developed after nasopharyngeal swab sample was taken, encephalocele stretching from right ethmoid roof to sphenoid sinus right lateral wall was detected, and repaired 

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Complications of nasal and pharyngeal swabs: a relevant challenge of the COVID-19 pandemic?

CSF rhinorrhoea post COVID-19 swab: A case report and review of literature

Cerebrospinal fluid leak after nasal swab testing for coronavirus disease 2019

CSF Leak After COVID-19 Nasopharyngeal Swab: A Case Report. The Laryngoscope

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The authors declare that they have no conflict of interest.Ethical approval Informed consent of the patient was obtained prior to the writing of the manuscript.

It is highly important that, in order to avoid complications during nasopharyngeal swab sampling for Covid-19 diagnosis, the medical people should be trained in details, and samples should be taken with correct application of method. Unilateral transparent nasal discharge after nasopharyngeal swab sampling should warn the clinician for possible CSF rhinorrhea.Authors' Contributions All authors meet the ICMJE authorship criteria. All authors have seen and approved the final version of the manuscript, and contributed significantly to the work.

Funding The authors received no specific funding for this work.Availability of data and material The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.Code Availability no code available.