SESSION TYPE: Infectious Disease Case Report Posters II
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: The clinical entity of Pott’s Puffy tumor is a subperiosteal abscess associated with osteomyelitis of the frontal bone. Here we describe a case of Pott’s Puffy tumor involving the frontal sinus, spreading to subdura leading to intracranial abscess and septic emboli to the lungs.
CASE PRESENTATION: 43 year old male with history of cocaine abuse and HIV was admitted with altered mental status. On exam he had large swelling of the right frontal bone with proptosis. He was diagnosed with sinusitis, multiple dural venous thromboses, subdural empyema and intra-cranial abscesses resulting in midline shift on head CT. Hypoxemic respiratory failure developed requiring intubation with associated finding of multiple bilateral cavitary lung abscesses in the bases. Subsequently he underwent drainage of the right frontal sub-periosteal abscess as well as left temporal craniotomy and evacuation of subdural empyema. Sepsis developed and he was treated for Streptococcus mitis which grew from sub-periosteal abscess. Despite initial ceftriaxone, metronidazole and ciprofloxacin therapy, fevers persisted leading to a 6 week course of meropenem. Oxygenation improved and patient made full neurologic recovery.
DISCUSSION: An increasingly rare disease in the era of antibiotics, Pott’s Puffy tumor was first described by Sir Percival Pott in association with head trauma. Since its description, observations have been increasingly associated with frontal sinusitis. Pott’s Puffy tumor is often an indicator of intracranial complications, however pulmonary manifestations are usually not associated with Pott’s. It begins as an infection of the frontal sinuses which originally manifest as periorbital swelling, headache and fever. Complications arise through the spread of the infection via valveless diploic veins in the skull or direct extension to the subdural space. Both methods of spread are illustrated in this case and particularly unique is the pulmonary manifestation of septic emboli which led to a large abscess formation. The infection is usually caused by Streptococcus however Haemophilus influenza and anaerobes have been described. Treatment includes surgical drainage and intravenous antibiotics for 6-8 weeks.
CONCLUSIONS: In the antibiotic era, patients developing Pott’s Puffy tumor has become less common. Knowledge of the sequelae including intracranial and pulmonary involvement of this disease can prove to be useful. This would allow for identification of the disease process and timely intervention. Prompt drainage of frontal and intracranial abscess and early antibiotic therapy, as illustrated in this case, are essential in the treatment of Pott’s Puffy tumor.
1) Kombogiorgas D, Solanki GA. The Pott puffy tumor revisited. J Neurosurg. 2006 Aug:143-9.
DISCLOSURE: The following authors have nothing to disclose: Bryan Husta, Cristina Reichner
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