Purpose: Orbital cellulitis is a serious condition with potentially severe complications. Treatment requires interdisciplinary care and early introduction of antimicrobial therapy. In our tertiary center, a team of pediatricians, pediatric ophthalmologists, and otorhinolaryngologists successfully participated in the management of pediatric periorbital/orbital cellulitis. This study aimed to demonstrate our interdisciplinary approach and to investigate clinical profile and management of pediatric periorbital/orbital cellulitis. Methods: A retrospective chart review was performed of all pediatric patients hospitalized for periorbital and orbital cellulitis in a tertiary hospital center from September 15, 2016, to March 15, 2020. Results: A total of 26 children—median age 2.7 years (range 0.5–12)—were treated during the study period. Disease presentation was unilateral, mainly during winter ( n = 12) and autumn ( n = 12), without ophthalmoplegia/proptosis. Seven patients had orbital cellulitis (Chandler classification of ≥III) and were older (6.5 years, P = 0.011) with sinusitis ( P < 0.001), required surgery ( P = 0.004), underwent longer antimicrobial treatment (13 days, P < 0.001), and had a longer length of hospital stay (13.43 days, P = 0.001). Orbital cellulitis occurred in a median of three days (range 1–12) of acute rhinosinusitis. Radiological survey was performed in 11 patients, whereas six patients were treated surgically. All intraoperatively collected cultures (sinus swabs) were positive, whereas Streptococcus pyogenes and Peptostreptococcus were isolated in five cases. All patients fully recovered. No recurrence was documented. Conclusion: Sinusitis is associated with severe orbital cellulitis and surgical management. Orbital cellulitis occurred early in the course of acute rhinosinusitis, as a distinctive presentation of rhinosinusitis. Interdisciplinary care and early management are crucial in treatment of pediatric periorbital/orbital cellulitis.

triglycerides=172 mg/dl) and indications of treatment with Medrol 2 mg/kg with gradual reduction of dosage and Aspirin 4mg/kg.After about 1 month he returns for revaluation, showing good general condition, upward weight curve, biological samples within normal limits.Ultrasound cardiological reassessment and CT angiography further reveal significant aneurysmal dilatation of the left coronary artery. Anticoagulant treatment was completed with enoxaparin.Conclusions KAWASAKI disease associated with COVID 19, may present an unfavorable outcome with lack of response to the initial immunoglobulin treatment and evolution to coronary aneurysm.

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