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

Öz

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. References 1. 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.

Anahtar Kelimeler

• Pott’s puffy tumor
• Frontal sinusitis
• Epidural empyema
• Ptosis
• Pediatric emergency

Adölesan Bir Hastada Atipik Oküler Bulgularla Seyreden Pott’s Puffy Tümörü: Olgu Sunumu

Öz

Giriş: Pott’s puffy tümörü (PPT), frontal sinüzitin nadir ancak potansiyel olarak yaşamı tehdit eden bir komplikasyonu olup frontal kemik osteomiyeliti ve subperiostal apse oluşumu ile karakterizedir. Tanının gecikmesi epidural veya subdural ampiyem, menenjit ve beyin apsesi gibi ciddi intrakraniyal komplikasyonlara yol açabilir. Frontal bölgede şişlik klasik klinik bulgu olarak kabul edilmekle birlikte, bu bulgunun eşlik etmediği atipik prezentasyonlar görülebilir ve özellikle pediatrik acil başvurularında tanısal gecikmeye neden olabilir. Olgu Sunumu: On iki yaşında erkek hasta, frontal bölgede şişlik veya nörolojik defisit olmaksızın, sol taraflı blefaroptozis ve tinnitus yakınmaları ile çocuk acil servise başvurdu. Daha önce herpes zoster oftalmikus ön tanısı ile tedavi edilmişti. Kontrastlı paranazal sinüs bilgisayarlı tomografisinde akut pansinüzit saptandı. Kontrastlı beyin manyetik rezonans görüntülemede frontal sinüs komşuluğunda epidural ampiyem ile uyumlu lezyon izlenerek Pott’s puffy tümörü tanısı konuldu. Geniş spektrumlu intravenöz antibiyotik tedavisi başlandı; radyolojik regresyonun yetersiz olması üzerine endoskopik sinüs cerrahisi uygulandı. Altı haftası intravenöz, iki haftası oral olmak üzere toplam sekiz haftalık antimikrobiyal tedavi sonrası hasta, nörolojik sekel olmaksızın tam klinik ve laboratuvar iyileşme ile taburcu edildi. Sonuç: Bu olgu, Pott’s puffy tümörünün klasik frontal şişliğin olmadığı durumlarda atipik oküler semptomlarla prezente olabileceğini göstermektedir. Sinüzit öyküsü olan ve açıklanamayan oküler bulgularla acil servise başvuran pediatrik hastalarda, klinik tablo hafif görünse dahi, erken ve kapsamlı görüntüleme yapılması potansiyel olarak ölümcül intrakraniyal komplikasyonların önlenmesi açısından kritik öneme sahiptir. References 1. 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.

Anahtar Kelimeler

• Pott’s puffy tümörü
• Frontal sinüzit
• Epidural ampiyem
• Ptozis
• Pediatrik acil

Kaynakça

1. 1. Daloiso A, Cattaneo L, Ferrari M, Schreiber A, Mattavelli D, Rampinelli V, et al. Pott’s puffy tumor in young age: A systematic review and our experience. J Clin Med 2024; 13(21): 6428.
2. 2. Koltsidopoulos P, Papageorgiou E, Skoulakis C. Pott’s puffy tumor in children: A review of the literature. Laryngoscope 2020; 130(1): 225-31.
3. 3. Tibesar RJ, Azhdam AM, Borrelli M. Pott’s puffy tumor. Ear Nose Throat J 2021; 100(6 Suppl): 870S-2S.
4. 4. Bambakidis NC, Cohen AR. Intracranial complications of frontal sinusitis in children: Pott’s puffy tumor revisited. Pediatr Neurosurg 2001; 35(2): 82-9.
5. 5. Vadiee G, Beshali M, Jahangiri S, Salimi M, Karimi A, Rahimi M. Pott’s puffy tumor: A case report. Clin Case Rep 2023; 11(6): e7815.
6. 6. Viana I, Nucifora ML, Vera L, Brea AB, Roitman P, Romani A. Pott’s puffy tumor: A rare complication of sinusitis. Arch Argent Pediatr 2024; 122(4): e202310151.
7. 7. Otto WR, Campbell A, Horn D, Schupper AJ, Greenhow TL, Bradley JS, et al. Suppurative intracranial complications of pediatric sinusitis: Predictors of outcome and role of early imaging. J Pediatric Infect Dis Soc 2021; 10(3): 309-16.
8. 8. Schupper AJ, Jiang W, Coulter MJ, Brar S, Oermann EK, Deveney CM, et al. Intracranial complications of pediatric sinusitis: An updated review. Int J Pediatr Otorhinolaryngol 2022; 154: 111031.

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