Nasopharyngeal COVID-19 Testing – Simple as ABC(SF Leak)?

Introduction: Routine nasopharyngeal swabbing for Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) testing for SARS-COV-2 (COVID-19) has become the recommended test for safely delivering both emergency and elective patient care. To date over 256 million tests have been conducted in the UK. Whilst the advantages of routine COVID-19 swabbing are evident, it is important to acknowledge the associated common complications as well as unusual ones such as a Cerebrospinal Fluid (CSF) Leak. Methods: We report a case of a 69-year-old female who underwent nasopharyngeal swabbing in preparation for routine elective surgery. At the 8-week follow up the patient complained of a runny nose, which was positive for Beta-2 Transferring thus confirming a CSF leak. The likely area of concern for the CSF leak was in the region of the left fovea ethmoidalis where the bone was extremely thin with a solitary fluid filled air cell. The patient did later report right eye surgery 2 years previously which resulted in postoperative ethmoidal sinusitis managed with antimicrobials. This may have predisposed her to the CSF leak. Results: Nasal swabbing has been shown to be the cause of a CSF leak in a handful of cases, only four thus far have been reported in the literature. This rare but important complication has a significant morbidity with risk of meningitis reaching 19 % in some reports. Conclusions: It is the author’s intention to raise awareness of CSF leak as a potential complication of COVID19 Swabbing to ensure these are recognised promptly and managed in a timely manner.