Shortly after a routine COVID-19 nasal swab, a U.S. patient sought care for intense headaches and vomiting. The swab had damaged the skull base, causing cerebrospinal fluid to leak from the nose.
Physicians at the University of Iowa Hospitals & Clinics detailed this unusual case in JAMA Otolaryngology–Head & Neck Surgery on October 1, 2020. The swab pierced a weakened area in the brain's protective barrier, linked to an undiagnosed condition and potentially improper swab insertion.
The patient received the nasal test prior to hernia surgery. Clear fluid soon dripped from one nostril, accompanied by headaches, vomiting, and neck stiffness. Clinicians confirmed a cerebrospinal fluid leak—the fluid that cushions and protects the brain within the skull.
Though the patient felt the swab went too deep, the core issue stemmed from prior treatment for intracranial hypertension. A needle used to drain excess fluid had caused an encephalocele, where brain tissue protrudes through the skull base into nasal cavities. This went undetected for years.
The patient recovered fully, but an untreated leak risked life-threatening brain infection. Experts note the swab didn't erode the skull base directly but traumatized the existing encephalocele. Strict protocol adherence is essential, they stress.
Patients with sinus surgery history should request oral or saliva tests. The authors urge vigilance and broader consideration of alternative screening methods, especially for those with skull base risks.
