Page 60 - Revista Portuguesa - SPORL - Vol 62. Nº2
P. 60
Case description abscess presented abundant pus discharge,
We present a case of a 12-year-old patient unlike the sinus drainage, where the material
who manifested symptoms of fever, purulent had mucous characteristics. Microbiology
rhinorrhea, and incipient frontal swelling. reported a Eikenella corrodens in the purulent
Oral antibiotics (amoxicillin - 500mg/ 8h) and discharge. The patient was treated initially
corticosteroids (prednisone - 0,5 mg/kg/24h) with an intravenous antibiotic combination of
were prescribed by the pediatrician but 48 cefotaxime (200 mg/kg/24h) and metronidazole
hours after initiating treatment symptoms (30 mg/kg/24h). After the culture result and
worsened with appearance of headache, a sensitivity tests, metronidazole was withdrawn
temperature of up to 39 degrees, and increase since isolated treatment with a third-generation
of the frontal swelling (Fig.1) the patient was cephalosporin such as cefotaxime guarantees
referred to our center. coverage of gramm-negative microorganisms.
CT-scan presented occupation of the frontal The patient completed a 3-week intravenous
sinuses and the anterior ethmoidal cells, right treatment with cefotaxime only, continuing
preseptal cellulitis and a frontal subperiosteal after discharge with oral Levofloxacin
abscess (8x34x29mm) spreading intracranially for 3 more weeks. The patient was also
through a frontal epidural empyema evaluated by neurosurgery, who decided
(8x38x23mm) (Fig.2). on conservative management of the frontal
A limited endoscopic sinus surgery was epidural empyema with close monitoring. The
performed to remove ostiomeatal complex patient did not present any other neurological
pathology with drainage of the right maxillary symptoms besides the frontal headache. The
through an antrostomy, opening of the control MRI performed 2 weeks after drainage
anterior ethmoidal cells and a Draf I procedure confirmed radiological improvement of the
on the right frontal sinus, as it was the largest sinusopathy and absence of intracranial
and most affected sinus in the CT scan. Frontal collections, showing only residual meningeal
subperiosteal abscess was successfully drained uptake in the previous empyema region. The
through a supraorbital incision and a drain was patient recovered without sequelae.
left for 48 hours. The drainage of the frontal
Figure 1
Pott’s puffy tumor. Swelling in the frontal region due to a frontal subperiosteal abscess
170 Revista Portuguesa de Otorrinolaringologia - Cirurgia de Cabeça e Pescoço
