52. Pott’s Puffy Tumor: “I’m Not a Klingon, It’s an Abscess!”

Christopher Lee¹ and David Bahner¹

(1)

Department of Emergency Medicine, Wexner Medical Center at The Ohio State University, Columbus, OH, USA

Christopher Lee (Corresponding author)

Email: christopher.lee@osumc.edu

David Bahner

Email: david.bahner@osumc.edu

Keywords

PottsOsteomyelitisSinusitisPediatrics

Case

Pertinent History

An 18-year-old male presented with his roommate with 1 week of progressive forehead swelling and sleepiness. Patient had an upper respiratory infection starting 3 weeks ago with rhinorrhea, sore throat, and headache that progressed to sinus pain and fever. He saw his primary physician and was prescribed a 10-day course of amoxicillin. He had improvement of his symptoms but he did not feel completely back to baseline. For the past week, his headache has gotten worse and he noticed a tender bump on his forehead that had progressively gotten larger in addition to having low-grade fevers. This morning his roommate noticed that he was sleepier than usual and had an episode of vomiting, prompting him to bring the patient to the Emergency Department (ED). The roommate denied any knowledge of trauma and said that the patient was acting normally yesterday evening.

Pertinent Physical Exam

Except as noted below, the findings of the complete physical exam are within normal limits.

Vitals: Temperature 101.8, Heart Rate 100, Respiratory Rate 14, Blood Pressure 100/50, Saturation 99% on room air
Head, Ears, Eyes, Nose, and Throat (HEENT): Atraumatic, normocephalic, 3-cm diameter area of induration on the right forehead, tender to palpation, no overlying redness, drainage, nasal turbinates erythematous without drainage, bilateral tympanic membranes with intact light reflex.
Eyes: Pupils Equal, Round, Reactive to Light and Accommodation (PERRLA); Extraocular Movements Intact (EOMI); no injection
Cardiovascular (CV): Tachycardic, regular rhythm, no murmurs/rub/gallop, normal S1 and S2
Neuro: Somnolent, GCS 14 (E3, V5, M6), CNII-XII intact, Strength 5/5 bilaterally in upper and lower extremities bilaterally, intact sensation, no dysmetria.

Past Medical History/Social History/Family History

Noncontributory

Pertinent lab work
Test	Results 0700	Results 1200	Results 1500	Units	Normal range
WBC	12.3	15.5	17.9	K/uL	3.8–11.0 · 10³/mm³
Hgb	13.3	12.9	13.0	g/dL	(Male) 14–18 g/dL (Female) 11–16 g/dL
Lactate	2.1	2.7	3.1	mmol/L	<2.0
pH	7.32	7.29	7.23	–	7.35–7.45
ESR	70	86	90	mm/h	(Male) 0–22 mm/h (Female) 0–29 mm/h
CRP	132	139	145	mg/L	<3 mg/L
Creatinine	0.75	0.79	0.77	mg/dL	0.6–1.5 mg/dL

WBC white blood cell, Hgb Hemoglobin, ESR Erythrocyte sedimentation rate, CRP C-reactive protein

CT Head

2 cm × 2 cm periosteal abscess in the right frontal bone anteriorly. Bilateral frontal sinuses completely opacified. Adjacent to this abscess, there is a complex subdural fluid collection with 2 mm of right-to-left midline shift.

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