We describe a case of Potts puffy tumour in a 10 year old girl.
A previously well child presented to a district general hospital with a 48-hour history of fever, headache, diarrhoea, vomiting and neck pain. She was confused, meningitic, tachycardic, and tachypnoeic with O2 saturation of 78% in air. Initial investigations revealed a metabolic acidosis, white cell count of 16.9×109/L, platelets of 10×109/L, and CRP 185 mg/L. Chest x-ray showed bilateral consolidation. Initial diagnosis was atypical pneumonia with possible meningo-encephalitis. She was started on IV ceftazidime, metronidazole, aciclovir and clarithromycin. She developed respiratory distress and septic shock requiring ventilation and inotropes. She had a small swelling on her forehead. A CT head confirmed a supraorbital soft tissue swelling and frontal sinusitis but no intracranial involvement. Pus from the swelling grew Streptococcus constellatus. Potts puffy tumour was diagnosed. CSF from a lumbar puncture had 40 white cells with 22 polymorphs but no organisms. Further CT head revealed a left frontal pole extradural abscess and superior sagittal sinus thrombosis. She underwent a craniotomy for evacuation of extradural and subgaleal emypemas and frontal sinus debridement. She was successfully extubated on day 13 of admission. She remained on high dose intravenous benzyl penicillin and metronidazole for 4 weeks. She has no residual sequelae.
Potts puffy tumour is a rare complication of sinusitis in the post antibiotic era and Streptococcus constellatus is cause. Nevertheless it has the potential for significant morbidity including osteomyelitis, cranial emypemas and morbidity and early diagnosis is essential.