Peer Review Report For: Case Report: Invasive candidiasis of the head and neck in a five-month-old infant: A case study [version 2; peer review: 3 approved with reservations]

Invasive sino-orbital fungal infection is an uncommon, yet severe condition that is rare among immunocompetent individuals, with most cases typically occurring in those with compromised immune systems. In this study, we report the case of a 5-month-old immunocompetent infant who exhibited persistent dacryocystitis despite receiving broad-spectrum antibiotics. Subsequently, the patient developed ethmoiditis, orbital subperiosteal abscess, and ulceration of the hard palate. Mycological and histological samples were collected from the affected area. The combination of microscopy and PCR amplification allowed for the identification of the fungal agent Candida tropicalis . The patient underwent sinus surgery and surgical debridement, along with antifungal therapy. The treatment was successful, and the follow-up was uneventful for up to 6 months. To our knowledge, this is the first reported case of invasive sino-orbital candidiasis in an immunocompetent infant with dacryocystitis as the entry point. This study explores the clinical features, management approaches, and outcomes of this potentially fatal disease.