Pediatric Neurology 52 (2015) 250e251

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Visual Diagnosis

Pott’s Puffy Tumor Lubna Jafri MD a, Osman Farooq MD b, * a b

Dow University of Health Sciences, Karachi, Pakistan Department of Pediatric Neurology, University of Buffalo, Buffalo, New York

A previously healthy 11-year-old girl presented with a 10 day history of headache and swelling on her forehead (Fig 1). Three weeks earlier, she had an upper respiratory illness and progressively developed swelling and erythema around the left eye. The diagnosis of sinusitis was made, and she clinically improved after treatment with amoxicillin. Laboratory investigation revealed a white cell count of 15,300/mm3 with 72% polymorphonuclear leukocytes, 20% lymphocytes, and 8% monocytes. Cultures isolated Streptococcus intermedius as the pathogen. Computerized tomography of the head revealed erosion of the frontal bone (Fig 2A) and an abscess in the frontal subcutaneous tissue extending intracranially through the osseous defect (Fig 2B). Based on her clinical presentation and characteristic imaging findings, a diagnosis of Pott’s puffy tumor was made. Pott’s puffy tumor is a rare clinical entity characterized by osteomyelitis of the frontal bone. The infection erodes through the wall of the infected frontal sinus leading to the development of a subperiosteal abscess.1 In rare patients (as in ours), this abscess can extend intracranially (Fig 2B). It is a condition typically observed in adolescents, although it can present at any age. Diagnosis is made by computerized tomography demonstration of the defects in the frontal bone and opacification of sinuses. Magnetic resonance imaging typically reveals a subperiosteal abscess in the forehead.2 The most common isolated pathogens are Streptococcus species, Hemophilus influenza, and Staphylococcus species.1 Our patient underwent surgical drainage of the abscess with wound debridement and received intravenous antibiotics for 4 weeks. On follow-up 3 weeks after discharge, she remained well, with no neurological sequelae or residual abscess observed clinically or on repeat imaging.

* Communications should be addressed to: Dr. Farooq; Department of Neurology; Women & Children’s Hospital of Buffalo; 219 Bryant Street; Buffalo, NY 14222. E-mail address: [email protected] 0887-8994/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.pediatrneurol.2014.08.024

FIGURE 1. Child with left frontal swelling at the time of presentation. (The color version of this figure is available in the online edition.)

L. Jafri, O. Farooq / Pediatric Neurology 52 (2015) 250e251

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FIGURE 2. (A) Bone window of axial computerized tomography (CT) scan, with arrow indicating skull erosion in frontal bone. (B) Axial CT with contrast enhancement of the abscess capsule in the frontal subcutaneous tissue extending intracranially.

References 1. Kombogiorgas D, Solanki GA. The Pott puffy tumor revisited: neurosurgical implications of this unforgotten entity. Case report and review of literature. J Neurosurg. 2006;105:143-149.

2. Nicoli TK, Makitie A. Images in clinical medicine. Frontal sinusitis causing epidural abscess and puffy tumor. N Engl J Med. 2014;370:e18.

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