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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

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

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

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).

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.

References
1.
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.
2.
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.
3.
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.PubMedGoogle Scholar
4.
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.13.10874PubMedGoogle ScholarCrossref
5.
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. Published online July 22, 2020:NEJMsr2022263. doi:10.1056/NEJMsr2022263
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