An Iowa woman in her 40s suddenly started leaking cerebral fluid during a nasal swab test for a novel Coronavirus infection. Her doctors who reported the case said that this is the first recorded injury of its kind related to COVID-19 but it won't happen to everyone as the woman unknowingly had a rare skull condition that caused the incident.

The woman went to see her doctor as she was facing some issues, including neck stiffness, headache, runny nose, sensitivity to light, and unusual taste in her mouth. After diagnosis, some sort of mass on the right side of the nasal cavity was found. But the tests of the woman's snot revealed that it contained the spinal fluid.

The woman told her doctors that she recently did a swab test for COVID-19, even though she developed no symptoms. But after the test, she started experiencing runny nose and headaches, as well as vomiting feeling. Later the MRI report revealed what was the actual issue.

Testing
Swab Test Pixabay

The Unusual Case

As per the case report, which was published Thursday, Oct.1 in the journal JAMA, the MRI scan revealed that the woman had something known as an encephalocele, which is a sac-like projection of the brain and the membranes that cover it through an opening in the skull. It happens when the neural tube—the precursor to the central nervous system in a fetus—does not close completely during pregnancy.

Even though encephalocele, a very rare birth defect, is noticeable on an ultrasound or after the baby is delivered, in some cases when the opening is around the nasal cavity, these are small enough to remain undetected for years. In the case of the Iowa woman, the encephalocele was actually detected on a CT scan taken in 2017, but that time her doctors diagnosed her with a sinus infection.

CT scan of the Iowa woman
Brain computed tomographic image from 2017 in the coronal and sagittal planes demonstrating encephalocele situated over the fovea ethmoidalis prior to nasopharyngeal testing for COVID-19. Sullivan, et al/JAMA Otolaryngology–Head & Neck Surgery

A swab test is not comfortable but, in this case, the doctors found no evidence to support that the swab punctured the skull of the Iowa woman to cause the leak on its own. In the reports, the authors wrote that "we, therefore, theorize that the swab itself did not result in a violation of the bony skull base, but rather the invasive test caused trauma to the patient's pre-existing encephalocele."

However, the doctors have successfully drain some of her encephaloceles and used a tissue graft to plug up the opening. However, the doctors have suggested people with similar skull conditions or sinus injury to go for other ways than a nasal swab test for Coronavirus infection.