A Case of Traumatic Cerebrospinal Fluid Rhinorrhea Successfully Treated Using Intravenous Factor XIII Administration

Traumatic cerebrospinal fluid (CSF) rhinorrhea occurs around 2% of severe head trauma. We should find the fistula and surgically seal it or perform conservative therapy with bed rest with/without lumbar spinal CSF drainage. However, the fistula may not be identified, and treatment may sometimes be challenging. Blood coagulation factor XIII (factor XIII) is one of the blood coagulation factors. It also promotes fibroblast proliferation during the wound healing process. We herein reported a traumatic CSF rhinorrhea patient who was successfully treated using intravenous (IV) factor XIII administration. This report would contribute to the effectiveness of factor XIII administration in the treatment of traumatic CSF rhinorrhea. A 58-year-old man fell from a height of 1.5 meters and hit his forehead. He presented with numbness in both upper limbs but no paresis. Neck magnetic resonance imaging (MRI) revealed cervical spinal cord injury without a cervical vertebral or cranial fracture. He was conservatively treated and discharged after three months. He had been aware of rhinorrhea since the trauma but was treated as allergic rhinitis. A year after the trauma, he was diagnosed with traumatic CSF rhinorrhea. We confirmed a bit of rhinorrhea despite the seven-day bedrest, so we intravenously administered 240 international units of factor XIII every day for 10 days. After 10 days, there was no rhinorrhea at all, and the patient was discharged on the 28th day. He has had no recurrence of rhinorrhea after a three-month follow-up. Factor XIII administration might be useful to treat traumatic CSF rhinorrhea.