Pott’s puffy tumor in a one-year-old boy with von Willebrand disease: a case report

Background Pott’s puffy tumor (PPT) is a subperiosteal abscess and osteomyelitis of the frontal bone, a potential complication of frontal sinusitis. Bleeding disorders, such as von Willebrand disease (vWD), can be potentially life-threatening in the case of surgery if not managed preoperatively. This appears to be the first documented case report of a PPT along with vWD. Moreover, to the best of our knowledge, it may also represent the earliest presentation of Pott’s puffy tumor in Pakistan, occurring in a child as young as one year of age. Case presentation A one-year-old boy, a known case of vWD, presented with a six-month history of progressive forehead swelling with no other associated symptoms. On examination, there was a firm, non-tender 3 × 3 cm swelling on the forehead with an unremarkable neurological examination. Laboratory evaluation showed an elevated activated partial thromboplastin time (aPTT), revealing an underlying bleeding disorder. A non-contrast computerized tomography (CT) revealed a hypodense lesion with frontal bone erosion. A magnetic resonance imaging (MRI) of the brain revealed an intracranial abscess in the frontal region, leading to the diagnosis of PPT. Treatment involved preoperative optimization, followed by frontal craniectomy and capsulectomy, resulting in discharge on intravenous antibiotic therapy and subsequent complete resolution of symptoms. Conclusions This case underscores the critical importance of thorough preoperative evaluation and multidisciplinary management in patients with bleeding disorders undergoing surgery for rare complications such as PPT. It represents the first reported association of PPT with vWD, and possibly the youngest documented case in Pakistan, emphasizing the need for heightened clinical vigilance in similar presentations during early childhood.