SHM Converge Scientific Abstract ePoster Gallery-A Puffy Plot Twist

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This case describes a 12-year-old girl who presented with 14 days of progressive forehead swelling after recent frontal sinusitis treated with amoxicillin-clavulanate. Her swelling recurred after minor head trauma, despite no fever, normal vital signs, normal neurologic exam, and normal inflammatory markers.<br /><br />Head CT showed frontal scalp induration with mottling and thinning of the frontal bone, raising concern for Pott’s puffy tumor. MRI confirmed extensive sinus inflammation with an extracranial abscess over the anterior calvarium and frontal bone erosion.<br /><br />She was admitted for further workup and treatment. Management included IV ceftriaxone and metronidazole, consultations with pediatric otolaryngology, infectious disease, and neurosurgery, and endoscopic sinus surgery with washout on hospital day 3. Cultures grew Haemophilus influenzae from the intranasal sample and methicillin-sensitive Staphylococcus aureus plus Streptococcus mitis-oralis from surgical specimens. She completed 7 days of IV ceftriaxone and metronidazole after surgery, then transitioned to IV ertapenem via PICC to complete a total 4-week antibiotic course.<br /><br />The discussion highlights that Pott’s puffy tumor is a rare but serious complication of frontal sinusitis in children and adolescents, caused by frontal bone osteomyelitis with a subperiosteal abscess. Forehead swelling is the key clinical clue, even without systemic illness. Recent sinusitis and trauma increase suspicion. Early diagnosis, IV antibiotics, and prompt surgical involvement are essential to prevent intracranial complications such as epidural abscess, subdural empyema, and meningitis.<br /><br />The case emphasizes the important role of hospitalists in recognizing the diagnosis, coordinating multidisciplinary care, and ensuring safe treatment transition.

Asset Subtitle

Anika Kumar

Meta Tag

Author List Anika Kumar, Dana M. Foradori, DeAngila Jones, Sylvie Denuit

Category Clinical Vignettes

Concept Potts Puffy Tumor

Concept Forehead Swelling

Concept Frontal Bone Osteomyelitis

Concept Abscess

Concept Frontal Sinusitis

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic Children's

Presenting Author Anika Kumar

Track Pediatric

Keywords

Pott's puffy tumor

frontal sinusitis

forehead swelling

frontal bone osteomyelitis

subperiosteal abscess

pediatric case

MRI diagnosis

endoscopic sinus surgery

intravenous antibiotics

intracranial complications

Potts Puffy Tumor

Forehead Swelling

Frontal Bone Osteomyelitis

Abscess

Frontal Sinusitis