TORONTO — A woman with an undiagnosed skull defect started leaking cerebral fluid out of her nose after she received a COVID-19 test administered with a nasal swab, according to a new case report.

The report, published Thursday in the journal JAMA Otolaryngology – Head & Neck Surgery, described a singularly unusual situation, where the nasal swab disturbed a mass in the woman’s nasal cavity containing cerebrospinal fluid and brain tissue.  (See link for article)

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**Comment**

The article states that it’s not uncommon to screen patients for COVID before elective surgeries, which is what happened here. 

The patient had a COVID test prior to hernia surgery. A CT scan done in 2017 showed the skull issue existed then, but was misdiagnosed as paranasal sinus disease (inflammation of the sinuses).  She also had a medical history of high pressure in the brain due to CSF buildup.

They theorize the swab itself did not cause the hole in the patient’s bone.

The article states that CSF leaks are ‘rare’ but sometimes misdiagnosed as migraines or other headaches.

Important quote:

“As the number of daily COVID-19 nasal and nasopharyngeal swab specimen collection procedures increases, a greater burden is placed on the health care system to properly train clinicians and even the general public to safely perform nasal and nasopharyngeal swab testing,” the report stated. 

They suggested that alternative testing methods be used for patients with a history of sinus issues or skull base defects. (I would argue Lyme/MSIDS patients fit into this group)