Abstract
Pott's puffy tumor (PPT) is a rare but potentially life-threatening complication of frontal sinusitis, most commonly seen in children and adolescents. We report an unusual case of PPT in a 63-year-old man with a history of intranasal cocaine use, complicated by pachymeningitis. The patient presented with severe right eye pain, periorbital swelling, erythema, and purulent discharge. Initial imaging revealed right orbital cellulitis and erosive paranasal sinus disease, with a suspected frontal subgaleal abscess. Brain MRI confirmed the diagnosis of PPT, demonstrating acute-on-chronic pansinusitis, frontal bone osteomyelitis, subperiosteal phlegmon, and associated pachymeningitis. The patient was managed with broad-spectrum intravenous antibiotics, with surgical intervention considered. Notably, he demonstrated clinical improvement with medical management alone, including the resolution of periorbital edema. This case underscores the evolving epidemiology of PPT in the adult population and highlights the role of risk factors such as cocaine use and sinus osteoma. It also emphasizes the critical importance of early recognition and a multidisciplinary approach in managing PPT to prevent serious intracranial complications. Despite the anatomical complexity, conservative medical therapy can be effective in selected cases without immediate surgical indications.