Nasopharyngeal swab for the diagnosis of SARS-CoV-2 (COVID-19) infection complicated by severe pneumococcal meningitis.

The nasopharyngeal swab is the reference test for diagnosing coronavirus disease 2019 (COVID-19) and other respiratory pathogens. Although this procedure appears to be risk free and was performed thousands of times daily during peaks of the COVID-19 pandemic, as well as during influenza and bronchiolitis outbreaks, it can be associated with minor to serious risks. These range from simple epistaxis to breaches of the meninges and skull stalks. Some breaches occur in the presence of anomalies such as congenital, traumatic or surgical encephaloceles. Neuro-meningeal breaches can be complicated by bacterial infections. We report the case of a 57-year-old woman diagnosed with Streptococcus pneumoniae meningitis following a nasopharyngeal swab for reverse transcription polymerase chain reaction testing. She had been experiencing cerebrospinal fluid leakage for 1 year after a nasopharyngeal swab performed on an unidentified encephalocele. Antibiotic treatment followed by surgical repair of the encephalocele led to full recovery. Although nasopharyngeal swab tests seem simple, clear instructions are essential for both sample collectors and patients, and any complication, even minor, must be carefully considered. Bacterial meningitis is a serious disease that can cause death or irreversible neurological sequelae. The presence of clear fluid flow after a nasopharyngeal swab should prompt investigation for a meningeal breach. Detecting such a breach may reveal a pre-existing or newly formed malformation, allowing for specialized care to prevent severe complications such as meningitis.