Recurrent Pott's puffy tumor – atypical presentation of a rare disorder

Abstract

We report the case of a 14-year-old girl who presented with an 8-week history of unilateral pansinusitis. In the course of the disease a right-side frontal swelling was observed, which disappeared following antibiotic treatment. Four weeks later, however, the swelling reappeared and was now diagnosed as recurrent Pott's puffy tumor. Interestingly, C-reactive protein levels were in the normal range throughout. Following functional endoscopic frontal sinusotomy, antibiotic treatment with ceftriaxone was administered over 3 weeks and led to complete remission of the lesion. Pott's puffy tumor is a subperiostal abscess of the frontal bone, usually presenting as localized swelling of the soft tissue in the overlying region of the forehead, and is associated with localized osteomyelitis and occasionally with intracranial epidural abscess. The entity has been known since 1768, although recurrent cases with normal inflammation parameters have not been published previously.

The Pott’s puffy tumor: a dangerous sign for intracranial complications

“…Most of the papers about this entity were presented as case reports and the majority of patients were in pediatric (adolescent) age group [2][3][4][22][23][24]. In the last decade, according to our knowledge, only four cases of Pott's tumor were reported in adults [8][9][10]21].…”

“…The patient with Pott's puffy tumor requires imaging evaluation to document extra sinus involvement of infectious or inflammatory conditions [4,[29][30][31]. The current imaging technologies are CT or MRI.…”

“…Modern high-resolution CT scanners provide very precise soft tissue and bone images in which three-dimensional reformatting can also be done (Fig. 3b) [4,23].…”

“…Having first claimed that this lesion was led by trauma, Pott later described it as a consequence of frontal sinusitis in 1775 [1]. Even though it usually presents as a localized, tender swelling of the forehead, other symptoms are headache, periorbital swelling, purulent rhinorrhea, fever and vomiting [2][3][4].…”

Pott’s puffy tumour in the paediatric population

“…As pointed out by Tsai et al, pneumatisation of the frontal sinus occurs around the age of 6 years and continues into adolescence. Many paediatric reports are therefore in children of 6 years and above [2,3].…”