A 15-year-old male patient presented to an external center with headache and swelling that started in his left eye and occurred in his right eye and forehead on the next day. The laboratory tests performed in the external center showed a white blood cell (WBC) value of 15 600/mm3 and a C-reactive protein (CRP) value of 5.6 (normal: 0-0.5) mg/dL. A diagnosis of acute frontal sinusitis was made with an examination and the laboratory findings, and oral amoxicillin-clavulanate treatment was initiated at a dosage of 60 mg/kg/day. Netilmicin sulfate eye drops and sodium fusidate ophthalmic ointment treatment was initiated because of conjunctivitis. The patient, whose headache and swelling in the left eye and forehead continued during treatment, presented to our hospital when his symptoms did not regress.
At the time of presentation, the patient's vital findings were as follows: body temperature: 36.8 C, blood pressure: 110/70 mm Hg, apical heartbeat: 74 beats/min. On physical examination, his oropharynx was hyperemic, there was periorbital edema and 2x2 cm of local swelling infraorbitally, hyperemia and local increase in the heat (Fig. 1a). There was marked postnasal purulent discharge and tenderness on the frontal region with palpation. The initial laboratory findings were as follows: WBC: 8.99 (74.5% neutrophil, 16% lymphocyte, 7.7% monocyte), hemoglobin (Hb): 15 g/dL, hematocrit (Hct): 42.2%, mean corpuscular volume (MCV): 92.9 fL, platelets (Plt): 333 000, CRP: 102 (normal: 0-8) mg/dL, erythrocyte sedimentation rate (ESR): 52 mm/h. Routine biochemical tests were found to be normal.
Treatment with intravenous ceftriaxone (75 mg/kg/day) and teicoplanin (a loading dosage of 16 mg/kg/day on the first day and a maintenance dosage of 8 mg/kg/day subsequently) was initiated with a prediagnosis of Pott's puffy tumor as a complication of frontal sinusitis. The paranasal sinus CT revealed increased mucosal thickness and appearance of a collection and a sclerotic lesion (osteoma?) in both frontal sinuses (with a size of 42x28 mm with lobulated contours in the widest part in the coronal plane extending to the left ethmoid cells on the left side), and an erosion in the anterior wall of the frontal sinus adjacent to the lesion described (Fig. 1b). On the second day of hospitalization, the patient was consulted by Opthalmology and Otorhinolaryngology clinics. The opthalmology consultation resulted as follows: "Full vision, eye movements are free and painless in all directions, no cell was observed in the anterior camera on biomicroscopic examination and bilateral fundi are natural." The patient was assessed by the otorhinolaryngology department and it was thought that excision of the mass, which was thought to be an osteoma, would be appropriate, because it eroded the anterior wall of the frontal sinus, and the sinusitis that developed was complicated by the development of subperiostal abscess (Pott's tumor). In the follow-up, the edema around the patient's eye and forehead reduced, and his headache improved. He was discharged with oral antibiotherapy after treatment with IV ceftriaxone and teicoplanin for 10 days. Following outpatient follow-up with antibiotherapy, the patient was hospitalized by the otorhinolaryngology department for surgery, mass excision was performed, and a histopathologic examination of the tissue obtained was found to be compatible with osteoma. Written consent was obtained from the patient who participated in the study and from his family.