A 28-year-old COVID positive man who developed orbital cellulitis -- a severe skin infection in the orbital area (around the eye) -- may represent an unusual complication of the infectious disease.

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Sinusitis related to COVID-19 may be a source of facial infection, suggested Vinicius Almeida Carvalho and his team at the State University of Londrina, Parana, Brazil. A few weeks before being presented to the craniofacial surgery department, the patient had developed mild illness with fatigue and loss of smell and taste, the team reported in The Journal of Craniofacial Surgery. He didn't seek medical care until he developed a headache and swelling around the eye, and loss of smell, which got progressively worse.

At his local emergency department, he was diagnosed with COVID-19, as well as sinusitis. However, despite antibiotics and other treatments for sinusitis, the facial pain and swelling worsened -- even as the patient's COVID-19 symptoms improved. By the time Carvalho's department saw him, the patient's eye was swollen and tightly shut. A computed tomography (CT) scan revealed a fluid collection that was putting pressure on the globe (eyeball), which was fortunately not yet damaged. The CT scan found no evidence of pneumonia or other respiratory involvement from COVID-19.

The patient was diagnosed with cellulitis -- severe infection under the skin -- which was thought to have spread from the sinuses to the orbital area. Because of the danger to the eye, Carvalho and colleagues performed urgent surgery, using a small incision to drain the collection of fluid and pus. The swelling around the eye decreased immediately after the procedure. The patient remained in the hospital for several days, including treatment with intravenous antibiotics. A few weeks later, his pain and swelling had resolved and the eye was functioning normally. A previous US paper reported sinus infection and orbital cellulitis as "atypical conditions" associated with COVID-19. Sinusitis is known to be an important cause of infections spreading to the orbital area.

"It is not clear whether SARS-CoV-2 itself is a contributing factor to the pathogenesis [development] in these cases," Carvalho said. Their case findings suggest that COVID-19 may contribute to sinus infection with the potential to spread to the area around the eye - even in an otherwise healthy young patient with mild COVID-19 symptoms. Whatever the course of the infection, the researchers emphasise the need for early surgery in patients with severe, vision-threatening orbital cellulitis.