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Introduction: Pediatric COVID-19 has been associated with various complications including chronic respiratory disease and multisystem inflammatory syndrome (MIS-C). Otolaryngologic symptoms are common and include sore throat, nasal congestion, and taste/smell disturbances; few cases of complicated sinusitis have been reported. We present a patient with recent COVID-19 who developed complicated sinusitis with intracranial extension and Lemierre’s syndrome.

Case Description: A 16-year-old female presented to the Emergency department with history of COVID-19 diagnosis 17 days prior. She reported worsening symptoms including headache, visual changes, and neck stiffness. Initial concerns for MIS-C prompted admission to the PICU. Exam showed left proptosis, Cranial nerve VI palsy, and limited neck range of motion. She was febrile to 104°F, hypotensive, with elevated WBC 12.7 and CRP 25. MRI brain revealed meningitis, bilateral cavernous sinus thrombosis, and a 3 x 2 x 3 cm sellar/clival abscess. A CT sinus showed severe sinus disease of bilateral sphenoid sinuses. CT neck showed thrombosis of bilateral internal jugular veins consistent with Lemierre’s syndrome. Patient underwent endoscopic sinus surgery including bilateral sphenoidotomies. Small bony dehiscence of the posterior sphenoid wall was identified. Sinus cultures grew Prevotella melaninogenica, Cutibacterium acnes, Staph epidermidis, and MSSA. Blood cultures grew Fusobacterium necrophorum. She was treated with multiple IV antibiotics. Anticoagulation was initiated after surgical intervention. Repeat MRI on postoperative day 20 showed improvement of sinus disease, cavernous sinus thrombosis, and intracranial abscess. Patients’ symptoms slowly improved, and she was discharged home on hospital day 21.

Discussion: This is the first pediatric report describing complicated sinusitis with an intracranial abscess, bilateral cavernous sinus thrombosis, meningitis, and Lemierre’s syndrome following COVID-19. Early surgical intervention, IV antibiotics, and anticoagulation were important for her recovery. Providers caring for patients with COVID-19 should keep complicated sinusitis and Lemierre’s in their differential. Future studies assessing the impact of COVID-19 on the pediatric sinonasal cavity are needed.

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