Aim: To report a rare case of acute sinusitis with simultaneous orbital and intracranial complications in an adolescent male and management of the same. Background: Acute sinusitis in the pediatric population is common and antibiotics are considered the mainstay of treatment. There is a decline in the incidence and associated mortality from complications associated with acute sinusitis with timely usage of antibiotics, better standards of living, and availability of medical care. However, there is a significant proportion of patients (5–40%) who suffer from complications mostly due to delay in the diagnosis. Complications involving multiple sites simultaneously is therefore rare in the present era of antibiotics. Case description: We report the case of a 15-year-old male with acute sinusitis who presented with orbital cellulitis and pachymeningitis with pneumocephalus. Orbital decompression with medial maxillectomy and frontoethmoidectomy was done and the pus drained when there was no improvement with intravenous antibiotics. There was a complete recovery after 1 month of treatment. Conclusion and clinical significance: A detailed and comprehensive history, clinical examination, and a high index of suspicion are essential in dealing with a case of pediatric sinusitis with complications as there is a risk of losing the child's vision as well as there is a likelihood of developing life-threatening intracranial complications. An expeditious multispecialty approach with an otolaryngologist, pediatrician, ophthalmologist, neurosurgeon, and microbiologist is often necessary to avoid any serious complications.