A COVID-19 nasal swab went deeply wrong when the swab test ruptured the lining at the base of a woman's skull causing cerebrospinal fluid to leak from the patient's nose, according to a study published Thursday by the peer-reviewed medical journal, JAMA Otolaryngology, which focuses specifically on diseases of the head and neck. The scientists who conducted the review write that, to their knowledge, this is the first reported incident of its kind.
The unnamed patient in her 40s was required to take a mandatory COVID-19 test before an elective hernia operation, the study said. She had an undiagnosed rare condition and the test may have been performed improperly, according to the study.
She began to experience a headache, vomiting, neck stiffness, a metallic taste in her mouth, and sensitivity to light, according to the report.
The study says the patient notified the hospital, which then conducted a CT scan, revealing a 1.8-centimeter pouch of CSF fluid pushing down on her sinus cavity. Her condition, known as encephalocele, was the result of her skull bones not closing completely, leaving a crack where her cerebrospinal fluid and brain tissue can accumulate, according to the report.
Jarrett Walsh, who practices at the University of Iowa Hospital and served as the lead researcher on the study, said he believes the symptoms she developed were a result of irritation to the lining of the brain. She could have developed a life-threatening brain infection if bacteria had traveled up the nose, the report said.
The risk from nasal tests remains very low, but health care professionals are being warned to follow protocols closely, according to Jarrett Walsh, senior author of the study. "It underscores the necessity of adequate training of those performing the test and the need for vigilance after the test has been performed," ear, nose and throat specialist Dennis Kraus of, Lenox Hill Hospital in New York, who had no involvement in the paper, told the outlet France24.
The report advised clinicians during testing to follow the path of the floor of the nose, which lies above the roof of the mouth, rather than pointing the swab up -- or if they point it up, to do so with great care.