879. Pott's Puffy Tumor: A Disease Making a Comeback
Session: Poster Abstract Session: Bone, Joint, and Soft Tissue Infection
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Posters
  • PottsPuffyTumorPoster.pdf (3.7 MB)
  • Background: Pott's Puffy Tumor (PPT), an entity of subperiosteal abscess and osteomyelitis of the frontal bone, occurs as a complication of chronic pansinusitis and is associated with intracranial extension. Clinicians need to be aware of its manifestations in order to appropriately treat their patients (pts). The objective of this study was to describe the epidemiology, clinical manifestations, treatment regimens, microbiology and clinical outcome of children with PPT.

    Methods: Retrospective chart review of pts hospitalized from 1995-2011 at Children's Memorial Hospital, a 273 bed free standing children's hospital in Chicago, IL, with ICD-9 discharge diagnoses of PPT, sinusitis with complications, osteomyelitis/abscess/cellulitis of face/skull, or intracranial abscess/infection.

    Results: 24 cases of PPT were identified; 18 of the cases (75%) occurred in the last 5 years of the study. The median age was 13.7 years (y) (range 3.3 to 15.8 y); 87.5% were male (M). 41.7% were Black (B), 33.3% White (W), 12.5% Hispanic, and 4.2% Asian. 9 pts (37.5%) received antibiotics (abx) within the prior month. The most common presenting symptoms include: headache (87.5%), forehead swelling/tenderness (87.5%), fever (75%), periorbital swelling (41.7%), and mental status changes (25%). Duration of symptoms ranged from 2 days (d) to 6 months (mos). Median length of hospital stay was 8 d (range 4-49 d). 23/24 (95.8%) pts required surgical intervention and had intracranial extension. Intracranial findings included: epidural abscess (91.3%), subdural empyema (30.4%), and subgaleal abscess (13%). Cultures were positive in 75% of cases; the majority were polymicrobial. Organisms isolated included: viridans Streptococci, Group C streptococci, Group F streptococci, oral anaerobes, and Staphylococcal species. Ceftriaxone, ampicillin/sulbactam and clindamycin alone or in combination were the most common abx used. Mean duration of therapy was 6 weeks (range 5 to 24 weeks). All pts recovered; 3 required admission to a rehab facility.

    Conclusion: PPT is occurring more frequently and is associated with intracranial extension in almost all cases. There is a clear M predominance especially in B and W adolescents in association with sinusitis. Disease is usually polymicrobial. Treatment requires a combination of prolonged abx therapy and surgical drainage.

    Tina Q. Tan, MD, Northwestern University Feinberg School of Medicine, Chicago, IL

    Disclosures:

    T. Q. Tan, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.