Differential diagnosis of pneumonia as a complication of nasal liquorrhea in the context of the COVID-19 pandemic: Case report

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Abstract

Nasal liquorrhea – the outflow of cerebrospinal fluid from the cerebrospinal fluid spaces of the cranial cavity into the nasal cavity or paranasal sinuses due to the presence of a congenital or acquired defect in the bones of the skull base and meninges of various etiologies. Nasal liquorrhea leads to potentially fatal complications: meningitis, meningoencephalitis, pneumocephalus, brain abscess. Also, with nasal liquorrhea, less dangerous complications may occur: aspiration bronchopneumonia and gastritis. The article presents a case of aspiration pneumonia in two patients with nasal liquorrhea treated at the Burdenko National Medical Research Center for Neurosurgery during the COVID-19 pandemic. Both patients noted the profuse nature of the nasal liquorrhea, complained of coughing in a horizontal position. In both cases, no RNA virus (SARS-CoV-2) was detected during the polymerase chain reaction. Antibodies (IgG, M) to coronavirus were not detected. Computed tomography of the chest organs in both cases revealed areas of frosted glass darkening. Since no data was obtained for coronavirus infection (negative tests for coronavirus, lack of antibodies), changes in the lungs were interpreted as a consequence of constant aspiration of CSF. The patients were admitted to a separate ward. Both patients underwent endoscopic endonasal plasty of the skull base defect. The postoperative period in both cases was uneventful. In both cases, the patients underwent computer tomography scan of the chest organs one month later. On the photographs, the signs of pneumonia completely regressed.

About the authors

Nadezhda A. Chernikova

Burdenko National Medical Research Center for Neurosurgery

Author for correspondence.
Email: Chernikhope@gmail.com
ORCID iD: 0000-0002-4895-233X

мл. науч. сотр., врач отд. оториноларингологии

Russian Federation, Moscow

Elizaveta V. Shelesko

Burdenko National Medical Research Center for Neurosurgery

Email: Chernikhope@gmail.com
ORCID iD: 0000-0002-8249-9153

канд. мед. наук, зав. отд. оториноларингологии

Russian Federation, Moscow

Oleg I. Sharipov

Burdenko National Medical Research Center for Neurosurgery

Email: Chernikhope@gmail.com
ORCID iD: 0000-0003-3777-5662

канд. мед. наук, нейрохирург отд. патологии основания черепа

Russian Federation, Moscow

Olga N. Ershova

Burdenko National Medical Research Center for Neurosurgery

Email: Chernikhope@gmail.com
ORCID iD: 0000-0001-9658-807X

д-р мед. наук, эпидемиолог

Russian Federation, Moscow

Pavel L. Kalinin

Burdenko National Medical Research Center for Neurosurgery

Email: Chernikhope@gmail.com
ORCID iD: 0000-0001-9333-9473

д-р мед. наук, зав. отд. патологии основания черепа

Russian Federation, Moscow

Maxim A. Kutin

Burdenko National Medical Research Center for Neurosurgery

Email: Chernikhope@gmail.com
ORCID iD: 0000-0002-6520-4296

канд. мед. наук, нейрохирург отд. патологии основания черепа

Russian Federation, Moscow

Dmitry V. Fomichev

Burdenko National Medical Research Center for Neurosurgery

Email: Chernikhope@gmail.com
ORCID iD: 0000-0002-5323-1000

канд. мед. наук, нейрохирург отд. патологии основания черепа

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1: a – axial projection; b – frontal projection. Computer tomography (CT) scan of the lungs of a patient with COVID-19 viral pneumonia. Symptom of “frosted glass” and “cobblestones”.

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3. Fig. 2: a – axial projection; b – frontal projection. CT of the first patient's lungs before surgery. Multiple “frosted glass“ areas are noted.

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4. Fig. 3. CT cisternography. Frontal projection. Defect in the area of the Turkish saddle.

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5. Fig. 4: a – axial projection; b – frontal projection. CT of the lungs one month after surgery.

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6. Fig. 5. CT of the brain, frontal projection. Defect of the skull base in the area of the lateral pocket of the sphenoid sinus on the left.

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7. Fig. 6: a – axial projection; b – frontal projection of CT of the chest organs before surgery. There are multiple areas of “frosted glass” darkening in the left lung.

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8. Fig. 7. CT of the lungs one month after surgery, frontal view.

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