{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T08:12:28Z","timestamp":1783757548922,"version":"3.55.0"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sage Open Medical Case Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>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\u2009days 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\u2009h. 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.<\/jats:p>","DOI":"10.1177\/2050313x261456987","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T06:32:20Z","timestamp":1783578740000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A case report and literature review: Cerebral spinal fluid leak after COVID nasopharyngeal swab testing"],"prefix":"10.1177","volume":"14","author":[{"given":"Jeremy","family":"Shi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, William Beaumont Army Medical Center, El Paso, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4073-8443","authenticated-orcid":false,"given":"Ya","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Pathology Service, HCA Houston Healthcare Clear Lake, Webster, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinyere","family":"Mbagwu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, William Beaumont Army Medical Center, El Paso, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2020.104821"},{"key":"e_1_3_2_3_2","unstructured":"Centers for Disease Control and Prevention. Interim Guidelines for Collecting Handling and Testing Clinical Specimens for COVID-19. CDC https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/lab\/guidelines-clinical-specimens.html (2020 accessed 29 July 2024)."},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.04430-2020"},{"issue":"4","key":"e_1_3_2_5_2","article-title":"Nasopharyngeal swab collection in the suspicion of Covid-19","volume":"41","author":"Piras A","year":"2020","unstructured":"Piras A, Rizzo D, Longoni E, et al. Nasopharyngeal swab collection in the suspicion of Covid-19. Am J Otolaryngol 2020; 41(4): 102551.","journal-title":"Am J Otolaryngol"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2022.37.e88"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2020.3579"},{"issue":"1","key":"e_1_3_2_8_2","article-title":"Meningitis due to cerebrospinal fluid leak after nasal swab testing for COVID-19","volume":"28","author":"Alberola-Amores FJ","year":"2021","unstructured":"Alberola-Amores FJ, Valdeolivas-Urbelz E, Torregrosa-Ortiz M, et al. Meningitis due to cerebrospinal fluid leak after nasal swab testing for COVID-19. Eur J Neurol 2021; 28(1): e91\u2013e92.","journal-title":"Eur J Neurol"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51082"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2021.01.003"},{"issue":"21","key":"e_1_3_2_11_2","article-title":"Iatrogenic cerebrospinal fluid leak after repeated nasal swab tests for COVID-19: illustrative case","volume":"2","author":"Ku J","year":"2021","unstructured":"Ku J, Chen CY, Ku J, et al. Iatrogenic cerebrospinal fluid leak after repeated nasal swab tests for COVID-19: illustrative case. J Neurosurg Case Lessons 2021; 2(21): CASE21421.","journal-title":"J Neurosurg Case Lessons"},{"key":"e_1_3_2_12_2","article-title":"A brief report: Cerebrospinal fluid rhinorrhea after repetitive nasal swab testing for coronavirus disease 2019(COVID-19)","volume":"20","author":"Y\u0131lmaz M","year":"2021","unstructured":"Y\u0131lmaz M, Bahad\u0131r Z, Madendere B, et al. A brief report: Cerebrospinal fluid rhinorrhea after repetitive nasal swab testing for coronavirus disease 2019(COVID-19). Otolaryngol Case Rep 2021; 20: 100313.","journal-title":"Otolaryngol Case Rep"},{"issue":"2","key":"e_1_3_2_13_2","article-title":"Cerebrospinal fluid leak from COVID-19 swab","volume":"5","author":"Agamawi YM","year":"2021","unstructured":"Agamawi YM, Namin A, Ducic Y. Cerebrospinal fluid leak from COVID-19 swab. OTO Open 2021; 5(2): 2473974X211059104.","journal-title":"OTO Open"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/ans.16910"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/jscr\/rjab456"},{"issue":"3","key":"e_1_3_2_16_2","first-page":"341","article-title":"Case report: an intracranial complication of COVID-19 nasopharyngeal swab","volume":"5","author":"Holmes A","year":"2021","unstructured":"Holmes A, Allen B. Case report: an intracranial complication of COVID-19 nasopharyngeal swab. 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