tetano
Editor, Senior Moderator
SAGE Open Med Case Rep
. 2026 Jul 8:14:2050313X261456987.
doi: 10.1177/2050313X261456987. eCollection 2026.
A case report and literature review: Cerebral spinal fluid leak after COVID nasopharyngeal swab testing
Jeremy Shi[SUP] 1 [/SUP], Ya Xu[SUP] 2 [/SUP], Chinyere Mbagwu[SUP] 1 [/SUP]
Affiliations
Coronavirus disease 2019 (COVID-19) swab testing has been commonplace since the onset of the pandemic, with few reported adverse effects beyond general discomfort. We report a rare clinical presentation of a cerebrospinal fluid leak following a nasopharyngeal COVID-19 swab. The patient, a 49-year-old female with a history of migraines, idiopathic intracranial hypertension (pseudotumor cerebri), fibromyalgia, depression, and prior traumatic brain injury, presented to the emergency department with a headache. The patient underwent nasopharyngeal swab testing 10 days before her visit. She experienced the immediate postprocedure onset of a global headache and clear nasal discharge that persisted until presentation. Physical examination revealed continuous clear rhinorrhea from the left nostril. Associated symptoms included blurry vision, nausea, vomiting, and postural instability. The patient was managed conservatively; the leak and associated symptoms resolved within 24 h. Computed tomography of the head and paranasal sinuses showed no overt skull base defect but revealed subtle dehiscence along the right optic canal and right foramen rotundum, as well as dilation of the optic nerve sheaths. These findings suggest elevated intracranial pressure, which may have predisposed the patient to a cerebrospinal fluid leak. Given the clinical history and temporal relationship, this is a presumptive cerebrospinal fluid leak secondary to the COVID-19 swab; however, no confirmatory testing was performed. Increased awareness of this adverse effect, particularly in patients with pre-existing risk factors, is essential for early diagnosis. Anterior nasal or mid-turbinate swabs may be safer for vulnerable patients, as nasopharyngeal swabs are more frequently linked to iatrogenic skull base injuries according to reported cases. To our knowledge, this represents the 15th reported instance of a post-swab cerebrospinal fluid leak and includes a comprehensive literature review.
Keywords: cerebral spinal fluid leak; coronavirus disease 2019 (COVID-19); nasopharyngeal swab testing.
. 2026 Jul 8:14:2050313X261456987.
doi: 10.1177/2050313X261456987. eCollection 2026.
A case report and literature review: Cerebral spinal fluid leak after COVID nasopharyngeal swab testing
Jeremy Shi[SUP] 1 [/SUP], Ya Xu[SUP] 2 [/SUP], Chinyere Mbagwu[SUP] 1 [/SUP]
Affiliations
- PMID: 42434065
- PMCID: PMC13351236
- DOI: 10.1177/2050313X261456987
Coronavirus disease 2019 (COVID-19) swab testing has been commonplace since the onset of the pandemic, with few reported adverse effects beyond general discomfort. We report a rare clinical presentation of a cerebrospinal fluid leak following a nasopharyngeal COVID-19 swab. The patient, a 49-year-old female with a history of migraines, idiopathic intracranial hypertension (pseudotumor cerebri), fibromyalgia, depression, and prior traumatic brain injury, presented to the emergency department with a headache. The patient underwent nasopharyngeal swab testing 10 days before her visit. She experienced the immediate postprocedure onset of a global headache and clear nasal discharge that persisted until presentation. Physical examination revealed continuous clear rhinorrhea from the left nostril. Associated symptoms included blurry vision, nausea, vomiting, and postural instability. The patient was managed conservatively; the leak and associated symptoms resolved within 24 h. Computed tomography of the head and paranasal sinuses showed no overt skull base defect but revealed subtle dehiscence along the right optic canal and right foramen rotundum, as well as dilation of the optic nerve sheaths. These findings suggest elevated intracranial pressure, which may have predisposed the patient to a cerebrospinal fluid leak. Given the clinical history and temporal relationship, this is a presumptive cerebrospinal fluid leak secondary to the COVID-19 swab; however, no confirmatory testing was performed. Increased awareness of this adverse effect, particularly in patients with pre-existing risk factors, is essential for early diagnosis. Anterior nasal or mid-turbinate swabs may be safer for vulnerable patients, as nasopharyngeal swabs are more frequently linked to iatrogenic skull base injuries according to reported cases. To our knowledge, this represents the 15th reported instance of a post-swab cerebrospinal fluid leak and includes a comprehensive literature review.
Keywords: cerebral spinal fluid leak; coronavirus disease 2019 (COVID-19); nasopharyngeal swab testing.