A Systematic Review of Intracranial Complications in Adults with Pott Puffy Tumor over Four Decades

A Rare Case of Pott's Puffy Tumor in an Adult With Paranasal Osteoma and Pachymeningitis

Pott's puffy tumor (PPT) is a rare but potentially life-threatening complication of frontal sinusitis, most commonly seen in children and adolescents. We report an unusual case of PPT in a 63-year-old man with a history of intranasal cocaine use, complicated by pachymeningitis. The patient presented with severe right eye pain, periorbital swelling, erythema, and purulent discharge. Initial imaging revealed right orbital cellulitis and erosive paranasal sinus disease, with a suspected frontal subgaleal abscess. Brain MRI confirmed the diagnosis of PPT, demonstrating acute-on-chronic pansinusitis, frontal bone osteomyelitis, subperiosteal phlegmon, and associated pachymeningitis. The patient was managed with broad-spectrum intravenous antibiotics, with surgical intervention considered. Notably, he demonstrated clinical improvement with medical management alone, including the resolution of periorbital edema. This case underscores the evolving epidemiology of PPT in the adult population and highlights the role of risk factors such as cocaine use and sinus osteoma. It also emphasizes the critical importance of early recognition and a multidisciplinary approach in managing PPT to prevent serious intracranial complications. Despite the anatomical complexity, conservative medical therapy can be effective in selected cases without immediate surgical indications.

Functional Endoscopic Sinus Surgery in Management of Pott's Puffy Tumor in a Pregnant Woman: A Clinical Case Report and Literature Review

PPT is a life-threatening intracranial complication, which is essential to be considered in both children and adults presenting with sinusitis symptoms.

A rare case report: Pott's Puffy tumor and Lemierre's syndrome with intracranial complications in an adult male

Pott Puffy Tumor (PPT) is extremely rare, yet potentially severe condition characterized by osteomyelitis of the frontal bone associated with one or multiple subperiosteal abscesses, primarily from nasosinusitis. It is characterized by localized frontal swelling accompanied by a subperiosteal abscess. Clinicians and radiologists do not widely recognize this complication of frontal sinusitis and, hence it is likely to be overlooked in clinical practice. We describe, through this article, a unique case of frontal osteomyelitis in an immunocompromised patient, complicated by a subperiosteal orbital abscess, subdural empyema, intracerebral abscesses, superior sagittal sinus thrombosis, and pulmonary septic emboli, which also resulted in septic pulmonary infarcts, aligning with Lemierre's syndrome. Treatment included a combination of antibiotics and surgery, with careful monitoring for orbital and intracranial complications.

Pott's puffy tumor with intracranial extension in a child with incontinentia pigmenti: case based review of the eponymous disease

BACKGROUND

Pott's puffy tumor (PPT) is an uncommon infection involving the frontal bone, first described by Sir Percival Pott more than 250 years ago. It can present with intracranial extension and serious neurological morbidity. Incontinentia pigmenti (IP) is a rare inherited genodermatosis that is lethal prenatally in males and manifests clinically in females. IP is associated with recurrent infections and immune dysfunction/suppression.

METHODS

We report a case of Pott's puffy tumor presenting in a child with IP. We also performed a literature review of reported cases of PPT associated with immune dysfunction. We discuss the clinical presentation, diagnosis, and management of these lesions.

RESULTS

We identified 12 cases of PPT associated with immune dysfunction/suppression. Diabetes was the most commonly identified cause followed by iatrogenic immunosuppression. Surgery is the standard treatment for managing PPT and the management of PPT with and without intracranial involvement, particularly in the context of underlying immune dysfunction/suppression, is discussed.

CONCLUSION

PPT remains a rare but not infrequent diagnosis, often requiring neurosurgical intervention. Immune dysfunction/suppression is an additional risk factor that may predispose to PPT. Early and aggressive management should be instituted for optimal outcome.

Pott's Puffy Tumor in Young Age: A Systematic Review and Our Experience

Background: Pott's Puffy Tumor (PPT) in young-age patients is a rare clinical entity characterized by osteomyelitis of the frontal bone with a subperiosteal abscess collection. Previous reviews primarily consist of small, retrospective case series and anecdotal reports. This study aims to present the largest, most up-to-date systematic review of essential clinical findings, diagnostic modalities, microbiologic considerations, and treatment approaches for managing PPT in pediatric and adolescent populations. Methods: PubMed, Scopus, and Web of Science databases were systematically screened until 3 January 2024. The protocol of this investigation was registered on PROSPERO in January 2024, and the systematic review was performed according to the PRISMA statement. The study included 184 patients from 109 articles and an additional case from the authors' institution. Results: PPT commonly stems from untreated rhinosinusitis, respectively, acute pansinusitis, frontal acute rhinosinusitis and chronic rhinosinusitis, and direct head trauma. Infections typically involve a polymicrobial anaerobe-predominant microbiome. Computed tomography and magnetic resonance imaging are routinely used for presurgical assessment and posttreatment surveillance. Intracranial complications were significantly associated with the type of surgical treatment (p value < 0.0001). Conclusions: PPT is a significant and relatively morbid disease often under-recognized and misdiagnosed due to its variable clinical presentation. Management includes both antimicrobial therapy and surgical intervention, emphasizing the importance of an interdisciplinary approach.

Osteomyelitis of Frontal Sinus: A Rare Sequelae of Acute Bacterial Sinusitis Associated With Anatomical Variations in the Frontal Sinus Drainage Pathway

Frontal osteomyelitis is characterized by localized osteal inflammation of the frontal bone. This is a rare complication of acute frontal sinusitis. The present case is being reported to highlight the likely role of anatomical variations in frontal sinus drainage pathways in the causation of this complication apart from other known predisposing factors like young age and immunocompromised state. The patient initially presented with seizures, fever, and headache and was diagnosed with viral encephalitis. However, the symptoms gradually progressed to cause right eye swelling and an increase in the severity of headache without any nasal complaints. Diagnostic nasal endoscopy revealed mucopurulent secretions in both nasal cavities. Computed tomography and magnetic resonance imaging diagnosed the anatomical variations, the extent of sinus involvement, and frontal osteomyelitis. Antimicrobial therapy for an extended duration of four weeks, along with functional endoscopic sinus surgery resulted in excellent outcomes.

Hospitalizations and severe complications following acute sinusitis in general practice: a registry-based cohort study

OBJECTIVES

To investigate complication rates of acute sinusitis in general practice, and whether antibiotic prescribing had an impact on complication rate.

METHODS

All adult patients diagnosed with sinusitis in Norwegian general practice between 1 July 2012 and 30 June 2019 were included. GP consultation data from the Norwegian Control and Payment for Health Reimbursements Database were linked with antibiotic prescriptions (Norwegian Prescription Database) and hospital admissions (Norwegian Patient Registry). Main outcomes were sinusitis-related hospitalizations and severe complications within 30 days. Logistic regression was used to estimate associations between antibiotic prescriptions, prespecified risk factors, individual GP prescribing quintile, and outcomes.

RESULTS

A total of 711 069 episodes of acute sinusitis in 415 781 patients were identified. During the study period, both annual episode rate (from 30.2 to 21.2 per 1000 inhabitants) and antibiotic prescription rate (63.3% to 46.5%; P < 0.001) decreased. Yearly hospitalization rate was stable at 10.0 cases per 10 000 sinusitis episodes and the corresponding rate of severe complications was 3.2, with no yearly change (P = 0.765). Antibiotic prescribing was associated with increased risk of hospitalization [adjusted OR 1.8 (95% CI 1.5-2.1)] but not with severe complications. Individual GP prescribing quintile was not associated with any of the outcomes, whereas risk factors such as previous drug abuse, or head injury, skull surgery or malformations, and being immunocompromised were significantly associated with increased risk of both outcomes.

CONCLUSIONS

Severe complications of acute sinusitis were rare and no protective effect of high prescribing practice among GPs was found. Recommendations to further reduce antibiotic prescribing are generally encouraged, except for high-risk groups.