Pott’s Puffy Tumor Managed in Resource-Limited Setting: A Case Report and Literature Review

Pott's puffy tumor is a serious complication of frontal sinusitis. Its recurrence following initial resolution is increasingly reported. However, spontaneous resolution is rare. We report the case of a 23-year-old male of African descent, presenting with a chronic left frontal swelling, purulent left nasal discharge, headache, blurred vision, and vomiting. Physical examination revealed proportionate right hemiparesis, and a left supraorbital draining fistula and a head computed tomographic scan suggestive of a pott's puffy tumor with intracranial extension. Bilateral subfrontal craniotomy and epidural empyema evacuation followed by a course of empiric antibiotherapy was done. Recurrence of frontal lobe abscess three weeks later in the context of new onset seizures prompted a needle aspiration culture identifying Streptococcus milleri, sensitive to Gentamicin and Kanamycin. The patient was placed on appropriate antibiotherapy, and anti-seizure drugs. Despite an initial loss to follow-up due to financial constraints, the patient returned one year later with no clinical or radiological evidence of pott's puffy tumor or intracranial suppuration.