Chronic Rhinosinusitis with orbital complication in Covid-19 patient: A Case Report

Background: The incidence of chronic rhinosinusitis (CRS) complications during the COVID-19 pandemic cannot be avoided. Limited access and restrictions cause the condition of CRS patients to get worse. One of these is orbital complications, which can involve the preseptal soft tissue, orbit, and adnexa. We present a complicated case treated multidisciplinary with a history of COVID-19 infection with symptoms of CRS and massive inflammation in the left side of the infraorbital area. Case presentation: A 48-year-old female with cellulitis in the nose left the infraorbital area with COVID-19 infection and uncontrolled diabetes mellitus. Patient complaints include nasal congestion, especially on the left side, nasal discharge, facial pain, and hyposmia lasting more than three months and worsening within a week. Our physical examination showed infraorbital cellulitis and a skin fistula with serous production. Nasal endoscopy showed a granulation mass visible from the left nasal cavity, thought to originate from the left maxillary sinus. The CT scan results with contrast showed a solid cystic mass mixed with bleeding within it in the left nasal cavity, left maxillary sinus, left ethmoid sinus, and extending to the left nasopharynx. The patient was explicitly isolated for COVID-19 and treated with diabetes mellitus regulation with double antibiotics. After the condition improved, the patient underwent functional endoscopic sinus surgery (FESS) and followed up for 3 months after surgery. Conclusion: This case highlights an orbital complication in CRS with preseptal cellulitis (Chandler's 1). In this case, CRS was worsened by the patient's immune condition due to uncontrolled diabetes mellitus and was exacerbated by a superimposed COVID-19 infection. Diagnosis, including history-taking, nasal endoscopy, and CT scan, is essential. Providing therapy with antibiotics, regulation of diabetes mellitus therapy, and FESS provide optimal results for patients. Routine postoperative follow-up is also essential to avoid recurrence in this case.