Presentations

Abstract

Introduction:

Pott's Puffy Tumor (PPT) is a rare complication of sinusitis characterized by swelling on the forehead due to frontal bone osteomyelitis and subperiosteal abscess. We present a case of a 10-year-old girl who presented with PPT as a complication of pansinusitis which further progressed to intracranial abscess and sagittal sinus thrombosis. We aim to provide an overview of the definitive treatment options and highlight potential complications associated with inadequate treatment.

Case Information:

A 10-year-old female patient presented in the ED with altered mental status, ataxia, fever, and lethargy which had begun as toothache and earache a week prior. MRI revealed a left frontal lobe abscess and a right frontal scalp abscess alongside pansinusitis. Pansinusitis was surgically debrided and managed medically. The intracranial abscess was drained twice and the frontal scalp abscess was aspirated. Cultures were positive for S. intermedius and antibiotics were de-escalated to penicillin and metronidazole from the initial broad-spectrum antibiotics with vancomycin and ceftriaxone. Superior Sagittal Sinus thrombosis (SSST) was noted on the initial MRI, however, anticoagulation was initially deferred until cleared from further operations. Heparin drip was administered with careful monitoring of acute hemorrhage. The patient was ultimately discharged home on 6-weeks course of penicillin, Keppra and Lovenox.

Discussion/Clinical Findings:

As illustrated by the case above, definitive treatment of Pott's Puffy Tumor involves a multidisciplinary approach combining medical and surgical interventions. The underlying sinusitis should be drained or debrided and may warrant functional endoscopic sinus surgery to correct sinus defects. Associated intracranial or extradural abscesses should also be drained and cultured. Prompt and appropriate antibiotic therapy should be administered following identification of the underlying infection. Heparin is first-line in the management of cerebral venous thrombosis.

Conclusion:

Complications arising from inadequately treated PPT may consist of incomplete resolution of the infection leading to extensive and persistent abscess formation, osteomyelitis of the frontal bone, or intracranial complications such as meningitis, brain abscess, or venous sinus thrombosis. These complications require more aggressive treatment modalities, including extended antibiotic courses and repeat surgical interventions. Inadequate treatment may also lead to chronic inflammation and bone destruction resulting in cosmetic deformities and functional impairments.