Pott's puffy tumor por Actinomyces tras trauma craneal leve

Abstract

Pott's puffy tumour (PPT) is a rare entity that involves scalp swelling associated with subperiosteal abscess and cranial osteomyelitis, occasionally accompanied by intracranial infection. It is usually affiliated with frontal sinusitis, which is a typical but infrequent complication. On the contrary, Osteomyelitis by Actinomyces is rare and usually occurs at the mandibular level, with very few cases of cranial osteomyelitis caused by this bacterial specie, especially after traumatic brain injury. We report an exceptionally unusual case of a PPT frontal tumor after blunt trauma (closed head injury), with an intracranial lesion whereby Actinomyces was isolated after surgery, as a co-participant of the mentioned infection besides Fusobacterium and Propionibacterium.

Pott’s Puffy Tumor - Overview of case series

“…13 PPT is a disease with low incidence and with few cases reported; this can be explained nowadays due to the widespread use of antibiotics. 29 The prevalence of PTT is higher among teenagers, because the venous drainage by diploic veins flow is increased during this stage of life, and can spread the infection easier, 4 other possible causes of this epidemiology is an anatomical characteristic, like late complete aeration of the frontal sinus 3,8,13,14 , which are often pneumatized by 2 years of age and are approximate adult size by the late teens. 3 But adults can be affected by the PTT, although rare, according to the world English-language literature, only 30-40 cases of adult patients with PPT were reported between 1990 and 2016.…”

“…3 But adults can be affected by the PTT, although rare, according to the world English-language literature, only 30-40 cases of adult patients with PPT were reported between 1990 and 2016. 8 The bacterial agents most often involved with PPT are Streptococci (Streptococcus milleri, Streptococcus viridians, Streptococcus pyogenes e Streptococcus pneumoniae), Staphylococcus aureus, and some anaerobic bacteria (Bacteroides and Fusobacterium 14,20,26,33 , Mycoplasma 27 , Klebisiella pneumoniae 28 and Pseuodomonas aeruginosa 30 ). These agents are the most common ones found in acute bacterial rhinosinusitis; an important fact is that most infections are caused by more than one etiologic agent.…”

“…35 This infectious agent propagating through mucosal venous drainage of the frontal sinus occurs through the diploic veins, which communicate with the Dural venous plexus or directly by erosion of the frontal sinus wall. 3,14,15 However, there is a possibility that the microbial study of purulent secretion may be uncontaminated, Clarós et al 31 reported 50% of sterile culture results, reflecting preoper-Linton S, Pearman A, joganathan V, Karagama Y. 32 Case report…”

“…Furthermore, another safe procedure, a valuable technique, made to ensure the efficacy of treatment was the endoscopic approach of the anterior ethmoid cells, sometimes amplified for the maxillary sinus. 8,14,16,21 The choice of the surgical procedure depends on the extent of the infection, as reported in Graph 1. 14,20,22 To increase the chances of a good prognosis, PPT should be suspected in all patients with sinusitis 17 , treatment must take into account the multidisciplinary approach, involving the ophthalmological vision 23 , that of the otolaryngologist, maxillofacial surgeon, neurosurgeon and the anesthetist, everyone can and should contribute to the patient's favorable evolution.…”

“…8,14,16,21 The choice of the surgical procedure depends on the extent of the infection, as reported in Graph 1. 14,20,22 To increase the chances of a good prognosis, PPT should be suspected in all patients with sinusitis 17 , treatment must take into account the multidisciplinary approach, involving the ophthalmological vision 23 , that of the otolaryngologist, maxillofacial surgeon, neurosurgeon and the anesthetist, everyone can and should contribute to the patient's favorable evolution. 24 In general, the prognosis is favorable, even if neurological symptoms are present upon admission, obviously, prompt diagnosis and aggressive treatment is mandatory in these cases for successful outcomes.…”