Pott’s puffy tumour and severe intracranial complications in a patient with schizophrenia: a case report

Abstract

Background: Pott’s puffy tumour is a subperiosteal abscess with cranial osteomyelitis. In compliant patients, antibiotic and surgical treatment is effective. However, patients with schizophrenia can present disease atypically, affecting the outcome and leading to life-threatening complications. Case presentation: We present a case where a 47-year-old man with schizophrenia declined surgery and follow-up of chronic frontal rhinosinusitis with a Pott’s puffy tumour. Nine months later he was found unconscious with osteomyelitis in his forehead, cerebritis and left-sided subdural empyema originating from the Pott’s puffy tumour. A multidisciplinary team of otolaryngologists and neurosurgeons performed acute endoscopic sinus surgery and craniotomy. Despite an intensive antibiotic treatment regimen and revision craniotomies, the patient suffered severe sequelae. Conclusion: Altered disease presentation and potential compliance issues must be kept in mind when treating psychiatric patients with severe and complicated sinonasal infection. This case illustrates the challenging interplay between rhinology and psychiatry.

Keywords

• pott's puffy tumour
• frontal sinusitis
• subdural empyema
• osteomyelitis
• schizophrenia