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.
CastagnoliRVottoMLicariA, et al. Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) infection in children and adolescents a systematic review. JAMA Pediatr. 2020;174:882-889. doi:10.1001/jamapediatrics.2020.1467
2.
LudvigssonJF.Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088-1095. doi:10.1111/apa.15270
3.
ZachariahPJohnsonCLHalabiKC, et al. Epidemiology, clinical features, and disease severity in patients with Coronavirus disease 2019 (COVID-19) in a children’s hospital in New York City, New York. JAMA Pediatr. 2020;174(10):e202430. doi:10.1001/jamapediatrics.2020.2430
4.
ConsiglioCRCotugnoNSardhF, et al. The immunology of multisystem inflammatory syndrome in children with COVID-19. Cell. 2020;183(4):968-981.e7. doi:10.1016/j.cell.2020.09.016
5.
FeldsteinLRRoseEBHorwitzSM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383(4):334-346. doi:10.1056/nejmoa2021680
6.
Godfred-CatoSBryantBLeungJ, et al. COVID-19-associated multisystem inflammatory syndrome in children – United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1074-1080. doi:10.15585/mmwr.mm6932e2
7.
AhmedMAdvaniSMoreiraA, et al. Multisystem inflammatory syndrome in children: a systematic review. EClinicalMedicine. 2020;26:100527. doi:10.1016/j.eclinm.2020.100527
8.
HolmesLJrEnwereMWilliamsJ, et al. Black-White risk differentials in COVID-19 (SARS-COV2) transmission, mortality and case fatality in the united states: translational epidemiologic perspective and challenges. Int J Environ Res Public Health. 2020;17(12):1-18. doi:10.3390/ijerph17124322
9.
DiMaggioCKleinMBerryCFrangosS.Black/African American communities are at highest risk of COVID-19: spatial modeling of New York City ZIP code-level testing results. Ann Epidemiol. 2020;51:7-13. doi:10.1016/j.annepidem.2020.08.012
10.
TurbinREWawrzusinPJSaklaNM, et al. Orbital cellulitis, sinusitis and intracranial abnormalities in two adolescents with COVID-19. Orbit. 2020;39(4):305-310. doi:10.1080/01676830.2020.1768560
11.
MaanASKaurGAroraRKaurJDeviKJSinghM.An unusual case of a pediatric nasal septal abscess with life-threatening complications in COVID-19 pandemic. Indian J Otolaryngol Head Neck Surg. Published online November 11, 2020. doi:10.1007/s12070-020-02264-3
12.
VahidyFSNicolasJCMeeksJR, et al. Racial and ethnic disparities in SARS-CoV-2 pandemic: analysis of a COVID-19 observational registry for a diverse US metropolitan population. BMJ Open. 2020;10(8):e039849. doi:10.1136/bmjopen-2020-039849
13.
SpethMMSinger-CorneliusTOberleMGenglerIBrockmeierSJSedaghatAR.Olfactory dysfunction and sinonasal symptomatology in COVID-19: prevalence, severity, timing, and associated characteristics. Otolaryngol – Head Neck Surg (United States). 2020;163(1):114-120. doi:10.1177/0194599820929185
14.
MehtaSPandeyA.Rhino-orbital mucormycosis associated with COVID-19. Cureus. 2020;12:e10726. doi:10.7759/cureus.10726
15.
Waizel-HaiatSGuerrero-PazJASanchez-HurtadoLCalleja-AlarconSRomero-GutierrezL.A case of fatal rhino-orbital mucormycosis associated with new onset diabetic ketoacidosis and COVID-19. Cureus. 2021;13:e13163. doi:10.7759/cureus.13163
16.
D’EliaRVHarrisonKOystonPCLukaszewskiRAClarkGC.Targeting the “Cytokine Storm” for therapeutic benefit. Clin Vaccine Immunol. 2013;20(3):319-327. doi:10.1128/CVI.00636-12
17.
MeduriGUKohlerGHeadleySTolleyEStentzFPostlethwaiteA.Inflammatory cytokines in the BAL of patients with ARDS: persistent elevation over time predicts poor outcome. Chest. 1995;108(5):1303-1314. doi:10.1378/chest.108.5.1303
18.
BannDVPatelVASaadiR, et al. Best practice recommendations for pediatric otolaryngology during the COVID-19 pandemic. Otolaryngol – Head Neck Surg (United States). 2020;162(6):783-794. doi:10.1177/0194599820921393
19.
McNeilJCDunnJJKaplanSLVallejoJG.Complications of otitis media and sinusitis caused by Streptococcus anginosus group organisms in children. Pediatr Infect Dis J. 2020;39(2):108-113. doi:10.1097/INF.0000000000002514
20.
BenningerMSManzR.The impact of vaccination on rhinosinusitis and otitis media. Curr Allergy Asthma Rep. 2010;10(6):411-418. doi:10.1007/s11882-010-0139-6
21.
OlarteLKaplanSLBarsonWJ, et al. Emergence of multidrug-resistant pneumococcal serotype 35B among children in the United States. J Clin Microbiol. 2017;55(3):724-734. doi:10.1128/JCM.01778-16
22.
DeutschmannMWLivingstoneDChoJJVanderkooiOGBrookesJT.The significance of Streptococcus anginosus group in intracranial complications of pediatric rhinosinusitis. JAMA Otolaryngol Neck Surg. 2013;139(2):157-160. doi:10.1001/jamaoto.2013.1369
23.
NagashimaHTakaoAMaedaN.Abscess forming ability of Streptococcus milleri group: synergistic effect with Fusobacterium nucleatum. Microbiol Immunol. 1999;43(3):207-216. doi:10.1111/j.1348-0421.1999.tb02395.x
24.
ShinzatoTSaitoA.A mechanism of pathogenicity of “Streptococcus milleri group” in pulmonary infection: synergy with an anaerobe. J Med Microbiol. 1994;40(2):118-123. doi:10.1099/00222615-40-2-118
25.
PatelZMFernandez-MirandaJHwangPH, et al. Letter: precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurg. 2020;87(1):E66-E67. doi:10.1093/neuros/nyaa125
26.
GiviBSchiffBAChinnSB, et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic. Otolaryngol Head Neck Surg. 2020;146(6):579-584. doi:10.1001/jamaoto.2020.0780
27.
ThambooALeaJSommerDD, et al. Clinical evidence based review and recommendations of aerosol generating medical procedures in otolaryngology – head and neck surgery during the COVID-19 pandemic. J Otolaryngol Head Neck Surg. 2020;49(1):28. doi:10.1186/s40463-020-00425-6
28.
WorkmanADJafariAWellingDB, et al. Airborne aerosol generation during endonasal procedures in the Era of COVID-19: risks and recommendations. Otolaryngol Head Neck Surg (United States). 2020;163(3):465-470. doi:10.1177/0194599820931805
