Abstract

SILVA, Maria João Coelho  and  DINIS, João Manuel Almeida. A case of sweet rhinorrhea. Rev Port Med Geral Fam [online]. 2020, vol.36, n.4, pp.350-354. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v36i4.12596.

Introduction: Spontaneous cerebrospinal fluid fistula is a rare entity and its aetiology is not well known, although it has been linked to benign intracranial hypertension. Diagnosis may be challenging, as it can be easily mistaken by other, more common, causes of rhinorrhea. Timely detection of this entity by the family doctor is essential to prevent the potentially serious complications it can lead to, such as neuro infection. Case description: Women, 64 years old, presents with liquid rhinorrhea and cough for months. Complementary diagnostic exams with the intent to exclude neoplastic, infectious, and allergic causes came out negative. The cough resolved with cessation of the angiotensin-converting enzyme inhibitor the patient was taking. Rhinorrhea remained and months later took semiological characteristics of a cerebrospinal fluid spontaneous fistula. Computed tomography did not reveal this cranial defect, but the measurement of glucose in the nasal fluid was compatible with that diagnosis. While the patient waited for urgent observation by neurosurgery, she developed meningitis, complicated with cerebral abscess. The presence of the defect was confirmed by the magnetic resonance of the brain, with associated signs of benign intracranial hypertension. The patient recovered without any sequel and the fistula resolved spontaneously. She is asymptomatic to the date, without rhinorrhoea or neuro infection. Commentary: Cerebrospinal fluid fistula was suspected by clinical manifestations even before the onset of complications. The most reliable exams to confirm that diagnosis is not readily accessible in the primary care setting. Nonetheless, and despite glucose measuring in the nasal fluid not being the most recommended exam, in this case, all the criteria for its reliability were met, and it was a fundamental tool for the management of the case. In the presence of a rare but potentially serious disease, the knowledge of its clinical manifestations and the correct use of simple diagnostic tools can be sufficient to make a diagnosis.

Keywords : Rhinorrhea; Spontaneous cerebrospinal fluid fistula; Glucose.

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