Late onset paediatric dacryoadenitis associated with SARS-CoV-2 confirmed by histological analysis

We report a case of chronic dacryoadenitis associated with SARS-CoV-2, confirmed by histological analysis. A previously healthy school-aged boy was admitted to the paediatric department with a 1 month history of both eyebrow swelling and very mild pain in the upper parts of both eyelids. Gadolinium-enhanced T1-weighted MRI revealed enlargement of both lacrimal glands. Clinicopathological analysis confirmed bilateral chronic dacryoadenitis. Topical steroids were given, resulting in slow resolution over 2 months, and clinical stability at 10 months. The patient had experienced mild respiratory symptoms and tested positive for SARS-CoV-2 antigen via PCR testing, diagnosed as SARS-CoV-2, 3 months prior to the onset of dacryoadenitis. Inflammatory cells around the lacrimal gland demonstrated immunoreactivity for SARS-CoV-2 nucleocapsid protein. However, PCR testing of lacrimal fluid for SARS-CoV-2 was negative. This case illustrates protean complications and suggests a probable pathogenetic mechanism of dacryoadenitis associated with SARS-CoV-2.