A Pott’s Puffy Tumor Associated with Epidural - Cutaneous Fistula and Epidural Abscess: Case Report

Abstract

Background:Pott’s puffy tumour is characterized by a fluctuate swelling of the frontal region as a result of osteomyelitis of the frontal bone. This inflammatory lesion may propagate endocranially, resulting in acute meningitis, epidural abscess, subdural empyema, cavernous sinus trombophlebitis, cerebritis, and frontal lobe abscess of the brain.Case Report:We present an unusual case of a 33-year-old man suffering from Pott’s puffy tumour whose condition was further complicated by a draining epidural-cutaneous fistula and an epidural abscess. We confirmed the diagnosis by contrast-enhanced computed tomography scanning and magnetic resonance imaging of the head. After intense antibiotic treatment, we performed a combined endoscopic and external surgical approach with drainage of abscesses, evacuation of pus and bone sequestrate and excision of fistulous lesion. The treatment was prolonged with four weeks’ antibiotic administration.Conclusion:Subperiosteal abscess of the frontal bone is an extremely rare complication of frontal sinusitis. This lesion may propagate endocranially, resulting in dangerous intracranial inflammatory lesions. Early diagnosis, medication and surgical therapy are very important in reducing morbidity and mortality.

Pott’s Puffy Tumor - Overview of case series

“…13 PPT is a disease with low incidence and with few cases reported; this can be explained nowadays due to the widespread use of antibiotics. 29 The prevalence of PTT is higher among teenagers, because the venous drainage by diploic veins flow is increased during this stage of life, and can spread the infection easier, 4 other possible causes of this epidemiology is an anatomical characteristic, like late complete aeration of the frontal sinus 3,8,13,14 , which are often pneumatized by 2 years of age and are approximate adult size by the late teens. 3 But adults can be affected by the PTT, although rare, according to the world English-language literature, only 30-40 cases of adult patients with PPT were reported between 1990 and 2016.…”

“…3 But adults can be affected by the PTT, although rare, according to the world English-language literature, only 30-40 cases of adult patients with PPT were reported between 1990 and 2016. 8 The bacterial agents most often involved with PPT are Streptococci (Streptococcus milleri, Streptococcus viridians, Streptococcus pyogenes e Streptococcus pneumoniae), Staphylococcus aureus, and some anaerobic bacteria (Bacteroides and Fusobacterium 14,20,26,33 , Mycoplasma 27 , Klebisiella pneumoniae 28 and Pseuodomonas aeruginosa 30 ). These agents are the most common ones found in acute bacterial rhinosinusitis; an important fact is that most infections are caused by more than one etiologic agent.…”

“…Besides, craniofacial traumas, surgery in the frontal region, a progressive thrombophlebitis without bone inflammation, intranasal cocaine abuse, and the several chronic diseases that affect the innate immune response, such as diabetes, chronic renal failure and aplastic anemia are also potential causes of Pott's puffy tumor. 8 Although rare, PPT represents an important morbidity rate with neurological involvement in 30% to 40% of all cases of PPT and may include motor deficit, aphasia, cranial nerve palsy, seizures, visual deficit, intracranial hypertension, obtundation, and coma. 1 The vast majority of patients treated appropriately recover without long-term neurological complications and sequelae.…”

The Unknown Cause of Pott’s Puffy Tumor – Importance of Early Diagnose

“…A hematogenous spread of the inflammatory content in the frontal sinus can occur through the diploic veins of the bone directly to the dural sinus. 6 Therefore, sinus thrombosis, subdural empyema, and intracerebral abscess are the most common complications. The destruction of the posterior wall of frontal sinus is much slower, so epidural abscess is a less frequent complication.…”

Tumor inflamatorio de pott. Descripción de un caso

“…La combinación ideal sería penicilina o vancomicina, cefalosporina de tercera generación y metronidazol. El uso de antibióticos debe extenderse al menos durante 4 a 8 semanas después de la cirugía [18]. El pronóstico, en general, es favorable, incluso si los síntomas neurológicos están presentes al ingreso; obviamente, el reconocimiento del cuadro y el tratamiento precoz oportunos son necesarios para obtener resultados exitosos [17].…”