Pott's Puffy Tumor Associated with Subperiosteal Empyema and Osteomyelitis in a Pediatric Patient

Pott's puffy tumor, a rare complication of frontal sinusitis or trauma, presents with subperiosteal abscess and osteomyelitis of the frontal bone. Early diagnosis with imaging studies and prompt treatment with antibiotics and percutaneous drainage of the abscess requires in most cases for a successful outcome. We report a case of a 12-year-old boy who initially presented with left sided retro-orbital/frontal area headache associated with high grade temperature and painful localized small forehead swelling. Symptoms developed few days after he had a dental extraction of left upper molar tooth. Initial workup showed raised inflammatory markers and a computed tomography scan (CT) of the brain was consistent with ethmoid/maxillary sinusitis. He was discharged home on his first presentation to a regional hospital after having intravenous antibiotics for 24 hours which were subsequently switched to oral antibiotics. He presented again after a week with recurrence of forehead swelling involving and extending into both retro-orbital areas associated with painful eye movements and few episodes of vomiting. Repeat imaging showed Pott's puffy tumour overlying the left frontal bone with underlying osteomyelitis. He was given intravenous antibiotics, abscess was surgically drained by the ear, nose, and throat (ENT) department, and he had a good clinical outcome on discharge with follow-up planned with ENT. Pott's puffy tumor, although rare, requires a high index of suspicion in patients presenting with frontal swelling and suggestive clinical features. Early diagnosis with CT scan and prompt treatment with antibiotics and percutaneous drainage, when indicated, can lead to a favorable outcome. Collaboration between clinicians, radiologists, and microbiologists is essential for optimal management of this potentially serious complication of frontal sinusitis.

Challenges in diagnosis The rarity and non-specific symptoms of Pott's puffy tumor, emphasizing the importance of maintaining a high index of suspicion, especially in patients with suggestive clinical features.Role of imaging The crucial role of computed tomography/magnetic resonance imaging scans in diagnosing Pott's puffy tumor and identifying complications like subdural empyema.Antibiotic selection The rationale behind the chosen broad-spectrum antibiotic regimen and the importance of tailoring therapy based on local resistance patterns and culture results.Surgical intervention The role of percutaneous drainage and other surgical procedures in managing Pott's puffy tumor, emphasizing their use in cases with large abscesses or inadequate response to antibiotics alone.Importance of collaboration The importance of collaboration between clinicians, radiologists, and microbiologists for optimal diagnosis, treatment planning, and patient management in cases of Pott's puffy tumor.