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Neurology

Cerebrospinal Fluid Leak After Nasal Swab Testing for Coronavirus Disease 2019

Educational Objective
To understand how a cerebrospinal fluid leak after nasal swabbing can affect testing for COVID-19

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: October 1, 2020

Observation

Article Information and Disclosures

Christopher Blake Sullivan, MD¹;

Adam T. Schwalje, MD, DMA¹;

Megan Jensen, MD¹;

Luyuan Li, MD¹;

Brian J. Dlouhy, MD²;

Jeremy D. Greenlee, MD²;

Jarrett E. Walsh, MD, PhD¹

Author Affiliations

¹Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City
²Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City

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In March 2020, coronavirus disease 2019 (COVID-19) emerged as a global pandemic. Testing for presence of active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is 1 pillar of the global response.¹ In particular, nasopharyngeal, anterior nasal, and midturbinate swabs are 3 of the 5 methods for initial diagnostic specimen collection recommended by the US Centers for Disease Control and Prevention (CDC).² However, complications associated with nasal swab testing are not well characterized. We describe the first case of a cerebrospinal fluid (CSF) leak after nasal testing for COVID-19, to our knowledge.

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Article Information

Corresponding Author: Jarrett Walsh, MD, PhD, Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 21264 PFP, Iowa City, IA 52242 (jarrett-walsh@uiowa.edu).

Published Online: October 1, 2020. doi:10.1001/jamaoto.2020.3579

Correction: This article was corrected on November 5, 2020, to fix an ommission in co-first authorship in the end matter.

Conflict of Interest Disclosures: Dr Walsh reported a patent to apparatus, systems and methods for negative pressure face shielding pending and a patent to apparatus, systems and methods for unified endoscopic procedure performance and visualization pending. No other disclosures were reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

Additional Information: Drs Sullivan and Schwalje were co-first authors.

References

World Health Organization. COVID-19 Strategic Preparedness and Response Plan, 2020. https://www.who.int/docs/default-source/coronaviruse/covid-19-sprp-unct-guidelines.pdf. Accessed July 29, 2020.

Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19. Published 2020. https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html. Accessed July 29, 2020.

Daele JJM , Goffart Y , Machiels S . Traumatic, iatrogenic, and spontaneous cerebrospinal fluid (CSF) leak: endoscopic repair. B-ENT. 2011;7(suppl 17):47-60. https://www.ncbi.nlm.nih.gov/pubmed/22338375.PubMed Google Scholar

Bialer OY , Rueda MP , Bruce BB , Newman NJ , Biousse V , Saindane AM . Meningoceles in idiopathic intracranial hypertension. AJR Am J Roentgenol. 2014;202(3):608-613. doi:10.2214/AJR.13.10874 PubMed Google Scholar Crossref

Tromberg BJ , Schwetz TA , Pérez-Stable EJ , et al. Rapid scaling up of Covid-19 diagnostic testing in the United States—the NIH RADx initiative. N Engl J Med. 2020;383(11):1071-1077. doi:10.1056/NEJMsr2022263 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.