Saif Ibrahim, Farah Al-Saffar, Robert W Regenhardt and Nilmarie Guzmán
Background: First described in 1760, Pott’s Puffy Tumor (PPT) is frontal bone osteomyelitis and sub-periosteal abscess complicated by frontal sinusitis. Currently, it’s a very rare complication due to the advent of Antibiotics and even more rare in adults than adolescents as developmental differences in cranial anatomy have been presumed to be the reason why more cases are seen in the younger age group. Only 32 adult cases are reported since 1990 to date. Most common organisms being streptococci, staphylococci, and anaerobes. The Case: 51 year old African American male patient presented with worsening frontal headache and a painful swelling on the forehead along with diplopia. Past history is positive for HIV, diagnosed 7 years earlier, not on antiretroviral therapy, in addition to surgery for head trauma 13 years prior. With appropriate medical and surgical management, the patient had significant improvement on examination and his diplopia resolved. Cultures from drainage grew Propioni bacterium sp. Discussion: We present a unique case of PPT on a patient with a history of head trauma and HIV, both acting as predisposing factors for his delayed presentation. This link may suggest a possible epidemiological transition in the trends of comorbidities predisposing to PPT since HIV prevalence has been in the rise. It is also a case with the longest documented latency period between head trauma and PPT presentation date. This, combined with unusual anaerobic bacterial isolates, make this new case report a pioneer in pointing out PPT’s association with novel risk factors.
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