Spontaneous CSF rhinorrhoea in a patient with factor VII deficiency: surgical and haematological considerations

A middle-aged woman presented with a 4-month history of watery nasal discharge and was diagnosed with spontaneous cerebrospinal fluid (CSF) rhinorrhoea. Routine blood tests revealed a prolonged prothrombin time (PT) leading to further evaluation and the incidental diagnosis of factor VII deficiency. To optimise safety before imaging, the patient received intravenous recombinant factor VII (NovoSeven, Eptacog alfa), after which CT cisternography demonstrated a persistent CSF leak from the cribriform plate. To avoid repeated recombinant factor VII administration, endoscopic endonasal repair of the defect was undertaken immediately, with meticulous intraoperative haemostasis. Her PT and international normalised ratio were closely monitored in the postoperative period. During more than 1 year of follow-up, she remained well with no recurrence. This case underscores the challenges of balancing haemostatic control during surgical intervention in patients with rare bleeding disorders. Notably, no prior reports in the literature describe CSF rhinorrhoea occurring in the setting of factor VII deficiency, making this presentation unique.