Rhino-orbito-cerebral invasive fungal sinusitis associated with COVID-19 infection in a malnurished child

BACKGROUND: Corona virus disease has been associated with a wide variety of fungal and bacterial co-infections. These secondary infections could be due to the irrational use of antibiotics, immunosuppressive therapy, pre-existing co morbidities, and immune modulator effects of the virus. But here, we report a very rare occurring of rhino-orbito-cerebral invasive fungal sinusitis in a malnourished child and no other co morbidities. CASE PRESENTATION: This is a case of a 6-year-old boy with severe thinness and no other co-morbidities, with mild COVID-19 infection, during the course of illness developed rhino-orbito-cerebral invasive fungal sinusitis. The child’s mother had COVID-19 1 week prior to child’s illness. The child then developed fever followed by headache. The child reported to hospital on seventh day of illness and RTPCR for COVID-19, turned positive. The child’s vitals were stable and maintaining saturation. Child was being treated with supplements and symptomatic treatment for fever. On his second day of stay at hospital, he started to develop gradually progressive left-sided peri-orbital swelling. Due to the association of COVID-19 with fungal infection, child was started on AMPHOTERICIN-B and given for 4 days and referred to a higher center for further management. Radiological imaging was suggestive of rhino-sinusitis with orbital cellulitis with meningeal enhancement suggestive of fungal etiology. Debridement was done, child was adequately treated with anti-fungal, and the child showed significant improvement along with radiological clearing. CONCLUSION: Invasive fungal infection can occur in association with COVID-19 among malnourished pediatric age groups with no other comorbidities.