A Deceptive Bump: The Case of a Complicated Pott's Puffy Tumor in a Symptom-Free Child

Background/Purpose: Pott's puffy tumor (PPT) is a rare entity characterized by osteomyelitis of the frontal bone with subperiosteal abscess formation, typically based on sinusitis. Timely diagnosis is crucial to avoid intracranial complications.

Methods: Hence, we report a complicated case of an 8-year-old boy with oligosymptomatic presentation.

Results: The patient presented after a transient 2-hour episode with reduced responsiveness and slow, “emotionless” speech. Seven days earlier, the patient had developed headache, forehead swelling, and subfebrile temperature and had received amoxicillin for sinusitis. On presentation to our clinic, no symptoms were apparent, but a single episode of vomiting. In a turn of events, on the third day of admission, a small protrusion reappeared on the patient's forehead. MRI imaging showed an acute sinusitis with frontal osteomyelitis and subperiosteal abscess (PPT). Remarkably there was also a prominent epidural and subdural abscess, causing perifocal edema and midline shift. Neurosurgical drainage was performed along with sinus surgery. Intravenous antibiotics and thrombosis prophylaxis were administered. After 4 weeks, the patient could be discharged in complete remission without deficits. Pott's puffy tumor typically presents with frontal swelling, headaches, nasal discharge, and fever. Incidence of intracranial complications in pediatric patients is high. Warning signs include nausea and vomiting, impaired vigilance, alteration of mental status, focal neurological deficits, and seizures. Our patient showed no cardinal signs of PPT on presentation. In spite of the serious complications, warning signs were limited to anamnesis of transient alteration of mental status and singular vomiting.

Conclusion: Forehead protrusion with sinusitis should be considered PPT until proven otherwise. Suspected PPT should prompt MRI and CT imaging. Surgical intervention along with broad antibiotic treatment is obligatory. Complicated cases can present oligosymptomatic in pediatric patients.

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Artikel online veröffentlicht:
13. November 2023