Sinusitis complicated by frontal bone osteomyelitis in a young patient

A 15-year-old male presented with acute left forehead swelling (Figure, A, arrow) and tenderness following a one-month history of worsening headache secondary to extensive frontal sinusitis. Imaging showed a scalp abscess, frontal bone osteomyelitis and underlying resolving sinusitis (Figure, B, arrow). Management included abscess drainage and bilateral endoscopic sinus surgery. Streptococcus anginosus was isolated and he completed a 6-week course of intravenous benzylpenicillin.

Pott’s puffy tumour — a rare clinical entity — is characterised by osteomyelitis of the frontal bone and associated subperiosteal abscess, usually related to frontal sinusitis.1 If unrecognised, it can lead to severe intracranial complications, including cranial nerve palsies and hemiparesis. Cultures reveal typical sinusitis pathogens.

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