Silent danger behind the forehead: Pott's puffy tumour presenting without systemic symptoms.
Ana Rita Rodrigues, Delfim Duarte, Nuno Oliveira
✦ AI-curated · Sources linked
Case in brief
A man in his 50s developed progressive, painless forehead swelling despite multiple courses of antibiotics, without systemic symptoms. Imaging showed bilateral subperiosteal collections and a right epidural empyema, consistent with Pott’s puffy tumour complicating frontal sinusitis. He received broad-spectrum antibiotics, endoscopic sinus surgery and external drainage; persistent collections led to a second-stage osteoplastic procedure. Cultures were sterile, possibly because antibiotics had been started early. After 6 weeks of parenteral antibiotics, the collections resolved, and he remained symptom-free at 8-month follow-up.
What made this case unusual
The presentation was painless forehead swelling without systemic symptoms, despite imaging evidence of bilateral subperiosteal collections and an epidural empyema.
Diagnostic / clinical pearl
Painless forehead swelling without systemic symptoms does not exclude advanced Pott’s puffy tumour; imaging can reveal associated intracranial infection.