Brain abscess as a complication of nasopharyngeal COVID-19 swab testing: Two case reports and a literature review

INTRODUCTION AND IMPORTANCE: The nasopharyngeal swab, which has experienced a marked increase in utilization during the COVID-19 pandemic and is considered the gold standard for COVID-19 testing due to its high diagnostic accuracy and sensitivity, The procedure is generally safe and well-tolerated, with pain, discomfort, and the urge to cough or sneeze being the most common complications. Though it is occasionally associated with serious complications. CASE PRESENTATION: we report two cases of brain abscess as a complication of nasopharyngeal COVID-19 testing. The first case was of a 47-year-old male diabetic patient with a positive medical history for immune thrombocytopenic purpura (ITP) who developed a frontal brain abscess one week after the swabbing procedure and was treated with systemic antibiotics followed by a successful functional endoscopic sinus surgery. The second case involved a hypertensive female patient in her 40s who also developed a frontal brain abscess on the same side as painful nasal COVID-19 testing. Systemic antibiotics were used to treat the patient. CLINICAL DISCUSSION: Serious adverse events from nasopharyngeal COVID-19 testing were reported to occur rarely, with incidences ranging from 0.0012 to 0.026 %. Retained swabs, epistaxis, and CSF leakage were commonly reported complications, which were frequently associated with high-risk factors such as septal deviations, pre-existing basal skull defects, and sinus surgeries. However, brain abscess complications are considered one of the extremely rare complications, with only a few cases reported in the literature. CONCLUSION: Appropriate approaches that depend on adequate anatomical knowledge are necessary for practitioners to perform nasopharyngeal COVID-19 testing.