Pott’s puffy tumour by Streptoccocus intermedius a rare complication of sinusitis

Description

An 8-year-old child presented with persistent fever, headache and a frontal swelling. The medical history was significant for recurrent episodes of upper respiratory tract infections and frontal headache. On physical examination, she showed a good performance condition and normal neurologic status. On palpation, a tender, fluctuating, doughy and warm mass (9×7 cm) in the forehead over the frontal sinus was found (figure 1). The head MRI revealed frontal, subcutaneous and epidural abscesses associated to inflammatory thickening of frontal sinus and ethmoidal cells (figure 2). Skin and soft-tissue infection, infected hematoma, tumours of the skin, soft-tissue and bone have been ruled out. The child was treated with antibiotic therapy coupled with subcutaneous and epidural accesses evacuation, with complete recovery. Pus culture grew Streptococcus intermedius. The organisms of this group are found in the human oral cavity and have a strikingly prominent association with brain abscess.¹ In our case, tooth infection has been ruled out. Pott’s puffy tumour is an uncommon complication of frontal sinusitis and of forehead trauma. It is a fairly rare but potentially life-threatening entity even in postantibiotic era, characterised by a swelling of the scalp due to a subperiosteal abscess associated to osteomyelitis in the frontal bone.² When a child presents with a fluctuating swelling of the forehead, imaging by CT or MRI should be done to confirm the diagnosis and exclude neurological complications. Antibiotic therapy and neurosurgery are essential to reduce mortality and morbility.³

Figure 1.

Pott’s puffy tumour. The child at the diagnosis.

Figure 2.

MRI: frontal, subcutaneous and epidural abscesses associated to breach in the continuity in anterior wall of frontal sinus.