Rapidly Progressive Complicated Acute Bacterial Sinusitis in the Setting of Severe Pediatric SARS-CoV-2 Infection

Abstract

Objective: This case report presents a case of a rapidly progressive complicated sinus infection in a child with the multisystem inflammatory syndrome in children. Methods: Case report with literature review. Results/Case Report: We present a novel case of severe rapidly progressive complicated sinusitis in a 14-year-old African American male diagnosed with the multisystem inflammatory syndrome in children. Infection was caused by an aggressive pathogen, Streptococcus intermedius (anginosus), and within 48 hours progressed to orbital, subgaleal, and intracranial abscess, requiring multidisciplinary intervention by ophthalmology, neurosurgery, and otolaryngology. Following surgical intervention and a 4-week course of intravenous antibiotic therapy, the patient had resolution of the infection with no neurologic sequelae. Conclusion: Despite the low incidence of multisystem inflammatory syndrome in children, physicians should be aware that immunologic changes and the cytokine storm induced by severe acute respiratory syndrome coronavirus 2 can potentially predispose patients to severe bacterial or opportunistic infections. As more cases of MIS-C develop, associated complications can become evident. Similar cases of SARS-CoV-2 and severe bacterial sinusitis have been published in the literature, but it remains unclear if there is an association between SARS-CoV-2 disease and an increased risk of complicated sinusitis in children.

Notes from the Field: Increase in Pediatric Intracranial Infections During the COVID-19 Pandemic — Eight Pediatric Hospitals, United States, March 2020–March 2022

“…During the first 2 years of the U.S. COVID-19 pandemic, pediatric centers anecdotally reported increased rates of intracranial bacterial infections, many of which were diagnosed during or immediately after an infection with SARS-CoV-2, the virus that causes COVID-19 ( 1 , 2 ). Although intracranial bacterial infections occur as a rare complication of partially treated or untreated bacterial rhinosinusitis in adolescents as well as mastoiditis in children of all ages ( 3 ), a 236% increase in cases among children was observed at a Michigan children’s hospital (Aldrich A and Ogrin S, Helen DeVos Children’s Hospital of Spectrum Health, unpublished data, 2022).…”

Lung abscess due to Streptococcus intermedius associated with SARS CoV‐2 infection in pregnancy: Unusual presentation and complication of a commensal bacteria during pregnancy

“… 21 In this case, the infection progressed to orbital, subgaleal, and intracranial abscesses, requiring surgical intervention and a 4‐week course of intravenous antibiotic therapy, with a resolution of the infection and no neurologic sequelae. 21 The second case describes the case of an adult older than 65 years with a medical history of SARS CoV‐2 infection who developed a subdural empyema due to SAG, for which he underwent two craniectomies, achieving the eradication of the empyema and clinical improvement, for which he underwent two craniectomies, achieving the eradication of the empyema and clinical improvement. 22 Finally, the third case describes a 12‐year‐old adolescent with SARS‐CoV‐2 infection who developed appendicitis with perforated gangrenous tissue, from which the purulent material was positive for E. coli, SAG, and SARS‐CoV‐2.…”

“…In regard to SARS‐CoV‐2 coinfection with Streptococcus intermedius , we reviewed the available medical literature in the major clinical databases (PubMed, Google Scholar, and SciELO). We found five articles, consisting of three case reports, 21 , 22 , 23 a case series, 24 and one cross‐sectional study. 25…”

“…21 In this case, the infection progressed to orbital, subgaleal, and intracranial abscesses, requiring surgical intervention and a 4-week course of intravenous antibiotic therapy, with a resolution of the infection and no neurologic sequelae. 21 The second case describes the case of an adult older than 65 years with a medical history…”

Pediatric COVID-19 Involving Complicated Sinusitis With Intracranial Extension and Lemierre Syndrome: A Case Report

“…A few cases of complicated sinusitis have been documented following SARS-CoV-2 infection [8][9][10]. Overall, complicated sinusitis is more common in the pediatric population, hypothesized to be a sequela of the anatomic differences in the sinonasal anatomy [11].…”