From sinusitis to blindness: an unusual case of Pott's puffy tumor with bilateral optic atrophy

Pott's puffy tumor (PPT) is a rare complication of sinusitis and is defined as a subperiosteal abscess with frontal bone osteomyelitis. Intracranial and orbital complications occur frequently.

A 17-year-old Senegalese male presented with febrile headache and right frontal swelling. Computed tomography (CT) revealed frontal empyema, orbital cellulitis, pansinusitis, venous sinus thrombosis, and septic pulmonary emboli. Despite antibiotic treatment, he required sinus exclusion, ethmoidectomy, and neurosurgical drainage. Cultures grew Haemophilus influenzae, Pseudomonas spp., and Neisseria spp.. Postoperatively, the bilateral optic atrophy led to irreversible blindness. Follow-up MR angiography revealed regression of the infection and sinus recanalization. Antibiotics and anticoagulants were discontinued after three months; the patient remained blind and awaited cranioplasty.

PPT often causes epidural or subdural abscesses; however, blindness is exceedingly rare.

PPT should be suspected in adolescents with persistent frontal swelling. Early multidisciplinary management is vital for preventing severe morbidities.