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1110 - An Interdisciplinary Approach to Pediatric Patient with Pott’s Puffy Tumor

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Co-Author(s)

RJ

Ryan L. Jensen, DO

Resident Physician
East Carolina University Health Medical Center
Winterville, North Carolina, United States

Presenting Author(s)

RH

Reid Huckabee, BS

Medical Student
Lincoln Memorial University-DeBusk College of Osteopathic Medicine
Bristol, Tennessee, United States

Co-Author(s)

MH

Morgan Howells-Resendez, MD

Resident Physician
East Carolina University Health Medical Center
Greenville, North Carolina, United States
AM

Abigail Morales, MD

Clinical Associate Professor
East Carolina University Health Medical Center
Greenville, North Carolina, United States

Case Diagnosis: Pansinusitis complicated by right-sided frontal bone osteomyelitis with subperiosteal abscess (Pott's Puffy Tumor)

Case Description: A 12-year-old male was admitted for pansinusitis complicated with by right-sided frontal bone osteomyelitis with intracranial extension and subgaleal fluid collection, but no drainable intracranial abscess noted. He required endoscopic sinus intervention with subsequent prolonged hospitalization. Right maxillary cultures isolated streptococcus pyogenes and cutibacterium avidium. Initially treated with vancomycin, Rocephin and Flagyl; however, coverage was broadened to meropenem monotherapy for 6 weeks. Hospital course complicated with agitation, new-onset status epilepticus requiring versed drip, then transitioned to Vimpat and Keppra. Functional impairment required max-total assistance for mobility and self- care. He was admitted to inpatient rehabilitation; however, progress towards goals was limited due to frequent outbursts and agitation. Multidisciplinary discussions in rehabilitation were held regarding significant agitation. Interventions were identified as a team which ultimately led to enhanced therapy participation and optimization of scheduled therapy time. This patient met all short-term therapy goals during a short 10-day inpatient rehabilitation stay.

Discussions: Pott’s puffy tumor is a rare complication typically associated with frontal sinusitis or frontal bone trauma. There is limited literature regarding the transition of care for these patients from an acute hospitalization to inpatient rehabilitation. Due to frontal lobe involvement, inappropriate behavior and agitation may impact a patient’s progress towards their therapy goals. Multidisciplinary discussions and tailored treatment plans may assist with a more successful transition from the acute hospital to an inpatient rehabilitation unit. In this case, involving medical family therapy in the discussion was particularly useful.

Conclusions: Multidisciplinary discussions and tailored treatment plans may benefit pediatric patients with Pott’s Puffy tumor who are limited by behavioral barriers.