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Pott's puffy tumor: An unusual complication of rhino-orbito-cerebral mucormycosis
Ananth P Abraham1, Abi Manesh2, Soumya Regi3
1Departments of Neurological Sciences, Christian Medical College Vellore, Tamil Nadu, India.
Objective:
To describe clinicoradiological features and surgical outcomes in a series of nine patients with rhino-orbito-cerebral mucormycosis (ROCM) who presented with Pott's puffy tumor (ROCM-PPT).
Methods:
The records of nine patients with ROCM-PPT seen between March 2020 and December 2021 were analysed. Clinical features, radiology, histopathology, operative findings, management and outcome were noted. Frontal sinus pneumatisation and outflow tract configuration was compared between patients and controls with ROCM and no PPT.
Results:
ROCM-PPT was diagnosed in 9 of 284 (3.2 %) patients with ROCM seen during the study period. There were six (66.7 %) males and the median age was 54 (IQR 46-60) years. Eight (88.9 %) patients had diabetes mellitus and seven (77.8 %) had been COVID-19 positive. Radiological features of osteomyelitis, subperiosteal abscess formation and dural enhancement were seen in all patients. No significant differences in pneumatisation or frontal sinus outflow tract configuration were noted between patients and controls. All patients underwent a craniectomy with frontal bone debridement and frontal sinus exteriorisation. All patients were treated with anti-fungal agents for several months. All patients had symptomatic improvement at a median follow-up of 21 (IQR 18-23) months. Repeat CT/MRI scans showed disease regression/resolution in six out of eight (75 %) patients with follow-up imaging, and stable disease in two others.
Conclusions:
ROCM-PPT is a rare, delayed complication of mucormycosis that was seen in larger numbers during the recent COVID-19 pandemic. Aggressive debridement of osteomyelitic bone and antifungal therapy results in a good outcome.
Insights
Rhino-orbito-cerebral mucormycosis with Pott's puffy tumor (ROCM-PPT) is a rare complication. Aggressive surgical debridement and antifungal treatment led to good outcomes in COVID-19 patients.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Ophthalmology
Background:
- Rhino-orbito-cerebral mucormycosis (ROCM) is a severe fungal infection.
- Pott's puffy tumor (PPT) is a rare, delayed complication of ROCM, particularly noted during the COVID-19 pandemic.
Purpose of the Study:
- To detail the clinicoradiological characteristics of ROCM with PPT (ROCM-PPT).
- To evaluate surgical outcomes for patients with ROCM-PPT.
Main Methods:
- Analysis of nine patients diagnosed with ROCM-PPT between March 2020 and December 2021.
- Review of clinical data, radiological findings, histopathology, surgical procedures, and patient outcomes.
- Comparison of frontal sinus anatomy between ROCM-PPT patients and controls.
Main Results:
- ROCM-PPT occurred in 3.2% of ROCM patients; 66.7% were male, median age 54.
- Diabetes mellitus (88.9%) and prior COVID-19 (77.8%) were common comorbidities.
- All patients showed osteomyelitis, subperiosteal abscess, and dural enhancement; all underwent debridement and antifungal therapy.
- Symptomatic improvement was observed in all patients at a median follow-up of 21 months, with disease resolution in 75% of those with follow-up imaging.
Conclusions:
- ROCM-PPT is a rare but significant delayed complication of mucormycosis, with increased incidence during the COVID-19 pandemic.
- Prompt and aggressive surgical debridement of infected bone combined with antifungal therapy is crucial for favorable patient outcomes.
