This case highlights a rare occurrence of Pott’s puffy tumor in an adult demographic. 

Pott’s Puffy Tumor (PPT) is a rare condition characterized by soft tissue swelling of the forehead due to underlying osteomyelitis of the frontal bone and a sub-periosteal abscess. Etiology is often linked to underlying sinusitis. Although primarily seen in children, it can occur in adults. Symptoms include headache, fever, nasal discharge, and swelling, with complications such as subdural empyema, abscesses, and thrombosis if untreated. Diagnosis in adults can be challenging, and neuroimaging including computed tomography (CT) and magnetic resonance imaging (MRI) are essential. Treatment involves broad-spectrum antibiotics targeting common pathogens like Staphylococcus and Streptococcus, along with surgical intervention. Early referral to specialists is crucial for proper management. 

A 63-year-old male presented with forehead swelling and tenderness two weeks after a mechanical fall. A CT scan revealed a 4.8 cm soft tissue swelling with sinus opacification and a cortical breach in the frontal sinus. Follow-up MRI showed a right-frontal abscess with erosion of the frontal bone. Patient had a history of dizziness and syncope but no prior sinus issues. His neurological exam was normal, except for localized scalp tenderness and peri-orbital bruising. A diagnosis of PPT with cranial osteomyelitis was made. He was started on empiric broad spectrum antibiotics and underwent a bi-coronal craniotomy with abscess evacuation. Cultures identified Streptococcus constellatus and Lactobacillus. Patient recovered well postoperatively and was later discharged with an 8-week course of intravenous Ertapenem.

In the modern era of medicine, Pott’s puffy tumor is an increasingly rare diagnosis, especially in the adult population. If suspected, early recognition and prompt treatment initiation are crucial for optimal outcomes. Treatment involves a multi-disciplinary approach. In majority of cases, broad-spectrum intravenous antibiotics with good blood-brain barrier penetration and surgical intervention remain the standard of care.