Clinical communication: Adult
Pott's Puffy Tumor and Epidural Abscess Arising from Pansinusitis

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Abstract

Background

Sinusitis is a common disorder that can result in rare but serious complications including periorbital or orbital cellulitis, intracranial abscess or meningitis, subperiosteal scalp abscess (“Pott's puffy tumor”), osteomyelitis, and cavernous sinus thrombosis.

Case Report

We report a case of a 41-year-old man who presented to our Emergency Department with pansinusitis. He did not obtain recommended follow-up treatment after discharge and 26 days later returned with a persistence of sinusitis, Pott's puffy tumor, and an intracranial abscess caused by Streptococcus intermedius. The patient required multiple otolaryngological and neurosurgical interventions and was treated with long-term antibiotic therapy.

Conclusions

Pott's puffy tumor is a complicated infection that requires intravenous antibiotic and surgical treatment. Diagnosis is made by contrast-enhanced computed tomography scan. Early treatment significantly contributes to favorable outcome and decreases the risk of further complications such as epidural abscess.

Introduction

Sinusitis is a common condition, but serious complications of sinusitis have become quite rare since the advent of antibiotics. It is estimated that 13% of the population of the United States suffers from chronic rhinosinusitis annually, making it one of the most common chronic diseases (1). Although uncommon, recurrent or chronic sinusitis can lead to periorbital or orbital cellulitis, intracranial abscess or meningitis, subperiosteal scalp abscess (“Pott's puffy tumor”), osteomyelitis, and cavernous sinus thrombosis. These serious complications of sinusitis are often subtle in their presentation but require prompt medical and surgical therapy to minimize potentially catastrophic sequelae. Particular attention should be paid to immunocompromised patients and intravenous (i.v.) drug abusers in the investigation of complications.

This case report describes a patient with chronic pansinusitis who presented to the Emergency Department (ED) with Pott's puffy tumor and an intracranial abscess requiring otolaryngological and neurosurgical interventions. This case demonstrates the importance of assuring adequate follow-up or immediate hospital admission, because the patient sought emergency medical attention before the abscess formed but did not pursue the recommended treatment with Otolaryngology after discharge from the ED. Although the patient appeared well clinically, the spread of the infection and the associated morbidity potentially could have been avoided with more aggressive initial management.

Section snippets

Case Report

A 41-year-old man presented with a 4-day history of headache, nasal discharge, and swelling of the left side of the forehead. The patient was alert and oriented. An oral temperature was 37.7°C (100°F), heart rate 92 beats/min, respiratory rate 20 breaths/min, blood pressure 125/81 mm Hg, and oxygen saturation (SaO2) 97% on room air. On physical examination, focal soft tissue swelling was noted without erythema or tenderness in the left frontal scalp region. The tympanic membranes were clear and

Discussion

Any discussion of Pott's puffy tumor must start with a review of sinusitis and clarification of the correct descriptive terminology. There is a continuum of the sinus disease processes and it is often difficult clinically to know exactly where on the continuum the patient lies. Rhinosinusitis refers to inflammation of the nasal and paranasal (ethmoidal and maxillary) sinus mucosa (2). Monosinusitis usually refers to limited inflammation of the maxillary sinuses but may actually be of any

Conclusions

Despite the rarity of cases of Pott's puffy tumor, it is a complicated infection that requires aggressive therapy and typically warrants hospital admission. Patients suffering from Pott's puffy tumor generally do not appear acutely ill and the physical examination findings may be subtle. This may lead the clinician to underestimate the urgency of this disorder. Proper diagnosis via contrast-enhanced CT scan is critical to assure prompt i.v. antibiotic administration and appropriate

References (20)

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