Pott’s Puffy Tumor in an Adolescent Presenting with Atypical Ocular Findings: A Case Report

Introduction:Pott’s puffy tumor (PPT) is a rare but potentially life-threatening complication of frontal sinusitis, characterized by frontal bone osteomyelitis and subperiosteal abscess formation. Delayed diagnosis may result in severe intracranial complications. Although frontal swelling is considered the hallmark clinical finding, atypical presentations without this sign may occur and lead to diagnostic delay, particularly in pediatric emergency settings.Case Report:A 12-year-old male presented to the pediatric emergency department with left-sided blepharoptosis and tinnitus, without frontal swelling or neurological deficits. He had been previously treated for presumed herpes zoster ophthalmicus. Contrast-enhanced paranasal sinus computed tomography revealed acute pansinusitis, while brain magnetic resonance imaging demonstrated an epidural empyema adjacent to the frontal sinus, consistent with Pott’s puffy tumor. Broad-spectrum intravenous antibiotic therapy was initiated, followed by endoscopic sinus surgery due to insufficient radiological regression. An eight-week antimicrobial regimen resulted in complete clinical and laboratory recovery without neurological sequelae.Conclusion:This case highlights that Pott’s puffy tumor may present with atypical ocular symptoms in the absence of classic frontal swelling. In pediatric patients presenting to the emergency department with a history of sinusitis and unexplained ocular findings, early comprehensive imaging is essential to prevent potentially fatal intracranial complications.References1.Daloiso A, Cattaneo L, Ferrari M, et al. Pott’s puffy tumor in young age: A systematic review and our experience. J Clin Med. 2024;13(21):6428.2.Koltsidopoulos P, Papageorgiou E, Skoulakis C. Pott’s puffy tumor in children: A review of the literature. Laryngoscope. 2020;130(1):225–231.3.Otto WR, Campbell A, Horn D, et al. Suppurative intracranial complications of pediatric sinusitis: Predictors of outcome and role of early imaging. J Pediatric Infect Dis Soc. 2021;10(3):309–316.4.Vadiee G, Beshali M, Jahangiri S, et al. Pott’s puffy tumor: A case report. Clin Case Rep. 2023;11:e7815.5.Viana I, Nucifora ML, Vera L, et al. Pott’s puffy tumor: A rare complication of sinusitis. Arch Argent Pediatr. 2024;122(4):e202310151.6.Tibesar RJ, Azhdam AM, Borrelli M. Pott’s puffy tumor. Ear Nose Throat J. 2021;100(6 Suppl):870S–872S.7.Schupper AJ, Jiang W, Coulter MJ, et al. Intracranial complications of pediatric sinusitis: An updated review. Int J Pediatr Otorhinolaryngol. 2022;154:111031.