Pott's Puffy Tumor Associated with Subperiosteal Empyema and Osteomyelitis in a Pediatric Patient.

Pott's puffy tumor, a rare complication of frontal sinusitis or trauma, presents with subperiosteal abscess and osteomyelitis of the frontal bone. Early diagnosis with imaging studies and prompt treatment with antibiotics and percutaneous drainage of the abscess requires in most cases for a successful outcome. We report a case of a 12-year-old boy who initially presented with left sided retro-orbital/frontal area headache associated with high grade temperature and painful localized small forehead swelling. Symptoms developed few days after he had a dental extraction of left upper molar tooth. Initial workup showed raised inflammatory markers and a computed tomography scan (CT) of the brain was consistent with ethmoid/maxillary sinusitis. He was discharged home on his first presentation to a regional hospital after having intravenous antibiotics for 24 hours which were subsequently switched to oral antibiotics. He presented again after a week with recurrence of forehead swelling involving and extending into both retro-orbital areas associated with painful eye movements and few episodes of vomiting. Repeat imaging showed Pott's puffy tumour overlying the left frontal bone with underlying osteomyelitis. He was given intravenous antibiotics, abscess was surgically drained by the ear, nose, and throat (ENT) department, and he had a good clinical outcome on discharge with follow-up planned with ENT. Pott's puffy tumor, although rare, requires a high index of suspicion in patients presenting with frontal swelling and suggestive clinical features. Early diagnosis with CT scan and prompt treatment with antibiotics and percutaneous drainage, when indicated, can lead to a favorable outcome. Collaboration between clinicians, radiologists, and microbiologists is essential for optimal management of this potentially serious complication of frontal sinusitis. LEARNING POINTS: