880. A Series of Pott’s Puffy Tumors in the Post-Antibiotic Era in Upstate New York
Session: Poster Abstract Session: Bone, Joint, and Soft Tissue Infection
Friday, October 19, 2012
Room: SDCC Poster Hall F-H
Background:

Indolent, swollen, circumscribed tumors of the forehead are known as Pott’s puffy tumors and first described in the 1700’s defined as subperiosteal abscesses of the frontal bone associated with osteomyelitis and often indicative of intracranial complications.  This condition was much more prevalent in the pre-antibiotic/pre-pneumococcal conjugate vaccine era but has now re-emerged and the numbers of cases have increased.  Chronic sinusitis is a challenge to treat and there has been a reluctance to prescribe antibiotics due to the difficulty in distinguishing bacterial from viral processes.  Early diagnosis with a combination of surgical and medical treatment is essential to avoid these complications. 

Methods:

We present five cases of adolescent males ages 9-15 years between 2010 -2012 who were diagnosed with osteomyelitis of the frontal bone with epidural, subgaleal and/or intracranial abscesses and compare them to 5 years of data collected from the Children’s Hospital in Albany, New York. 

Results:

All of the patients underwent computed tomography which confirmed the diagnosis.  Inflammatory markers such as erythrocyte sedimentation rate and c-reactive protein were used to monitor the patients.  Presenting symptoms included headaches, congestion, facial swelling as well as personality changes.  These patients failed or were not started on outpatient antibiotics.  Four patients required multiple surgical interventions including craniotomy with endoscopic sinus exploration and trephination requiring long hospital stays with reoccurrence.  A multitude of organisms grew from abscess drainage including streptococcus and staphylococcus aureus. In addition to extensive intracranial surgery, intravenous antibiotics were given for a minimum of six weeks. 

Conclusion:

Early diagnosis with a combination of surgical and medical treatment is essential to avoid these complications.  We evaluate the Infectious Disease Society of America’s (IDSA) guidelines regarding rhinosinusitis and recommendations for treatment.  There is a lack of reporting of cases of Pott’s puff tumors and we review cases found in the literature from 2010 onward.  Undiagnosed, untreated or partially treated sinusitis can lead to serious complications and may be under diagnosed in the primary care setting.

Jessica Kumar, MPH, DO, Internal Medicine-Pediatrics, Albany Medical Center, Latham, NY

Disclosures:

J. Kumar, 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.