This work was carried out in accordance with the Code of Ethics of the World Medical Association and the Declaration of Helsinki, as well as the requirements set by the local Institutional Review Board. Our patient is a 58 year-old female with a complex cardiac history involving double-inlet left ventricle surgical repair as an infant, complete heart block requiring a pacemaker, previous deep venous thrombosis of the legs, stage III chronic kidney disease, and cirrhosis. Her BMI was 33, and she did not have a suspected history of idiopathic intracranial hypertension. She suffered from recurrence ascites related to her right-heart failure and was to undergo an outpatient image-guided paracentesis. As part of the pre-operative screening process, she underwent nasal swab COVID-19 testing. Within 48 hours of her nasal swab testing, the patient noticed clear drainage from her nose. This was persistent and often associated with straining or upright position. She received outpatient testing of her rhinorrhea fluid with detected levels of beta2-transferrin, diagnosing CSF leak. Due to presence of a cardiac pacemaker, she was unable to undergo MRI of the brain. She received a head CT, which showed a small bony defect (~4-5 mm) in the left side of the posterior wall of the sphenoid sinus (Figure 1). No previous comparison images were available. Approximately eight weeks after this procedure, the patient was brought to the emergency department by her husband exhibiting fever, confusion, headache, neck pain, and fatigue. There were no grossly abnormal findings on physical examination. She was evaluated with the sepsis protocol, with lab studies showing WBC 60,000 cells/uL, lactic acid 2.2 mmol/L, and no alterations of electrolytes, ammonia, or renal function. She was admitted to the intensive care unit and begun and empiric antibiotics. Her blood cultures showed streptococcus pneumoniae. Urine culture showed no growth. She had no identified etiology for her bacteremia on positron emission tomography imaging of the chest, abdomen, or pelvis ordered by the infectious disease consultant. She was placed on bedrest and CSF rhinorrhea was noted to continue. The patient underwent a fluoroscopic-guided lumbar puncture to evaluate for meningitis, which was unsuccessful due to patient toleration and body habitus. Her rhinorrhea improved and mental status slowly improved, and no CSF leak was noted after several days of bedrest and head elevation. She received long-term intravenous access to allow outpatient antibiotics for the management of her sepsis. The infection disease specialist suspected that the patient’s septicemia was secondary to chronic CSF leak and related meningitis from nasal cavity seeding and planned for six weeks of ceftriaxone and vancomycin therapy. Because the patient had no previous cranial imaging, it is unknown if the bone defect in the sphenoid sinus was present prior to COVID nasal swab testing; this diagnostic test may be causal with regard to the patient’s CSF rhinorrhea. After two weeks of inpatient management she was discharged with close clinical follow-up.