Pott’s puffy tumour and the impact of medical misinformation in a New Zealand context

Pott’s puffy tumour (PPT) is a subperiosteal abscess of the forehead with associated frontal bone osteomyelitis, typically affecting adolescents.¹ Effective management relies on prompt medical intervention and adherence to evidence-based treatments to avoid life-threatening complications. However, rising health misinformation in New Zealand increasingly influences parental decision-making. Shifting attitudes towards medical professionals and prescribed therapies can cause significant delays in care, transforming manageable paediatric conditions into life-threatening emergencies.

Case report

A previously well, unimmunised 9-year-old child presented with a 1-week history of left upper eyelid swelling following a cat scratch to her left eyebrow. She was afebrile and systemically well with visual acuities of 6/6 bilaterally. Findings were consistent with preseptal cellulitis, and she was discharged on oral amoxicillin-clavulanate in keeping with local antibiotic guidelines.

Due to medical scepticism, the parents encouraged poor adherence to the antibiotic regime, instead utilising a dilute preparation of silver nitrate (AgNO₃) topically applied to the area of cellulitis twice daily.

Four days later, she re-presented to the ophthalmology department with worsening swelling and tenderness.

View Figure 1–2.

MRI confirmed the presence of Pott’s puffy tumour, pansinusitis, orbital cellulitis and a superior sagittal sinus thrombosis.

Following in-depth discussion on the risks of further delays to treatment, the parents consented to endoscopic sinus surgery and abscess drainage under general anaesthetic. Misinformation-driven parental hesitancy, including a reluctance to provide a home address for outpatient services, caused delays in discharging from hospital. Following a 6-week course of intravenous antibiotics, follow-up imaging confirmed resolution of the thrombosis and inflammation.

Discussion

This case highlights the aggressive potential of treatable infections in children and the avoidable consequences of poor medication adherence. Rapid progression to life-threatening intracranial complications, such as sinus thrombosis, can be avoided by identifying and addressing patient barriers to treatment.¹

In New Zealand and globally, medical care is increasingly complicated by rising health misinformation, which fosters mistrust in health professionals and their prescribed treatments.² Medical misinformation has massively increased following the COVID-19 pandemic and is correlated with an increase in social media use.^3,4 Such beliefs can lead to critical delays in care, including reluctance to escalate therapy or co-operate with a treatment regime. This creates a specific vulnerability for paediatric patients, who rely on parental adherence to evidence-based medicine.
Ideally, clinicians should employ proactive advocacy strategies to ensure parental co-operation with medical treatment without relying on evidence of disease progression to sway parental opinion.⁵ Early discussions around the treatment provided and any barriers the patient foresees can identify where further input is needed. Clinicians should approach these conversations with empathy and care to facilitate an open and honest dialogue. To provide accurate advice, clinicians must also be well versed in interpreting research quality and reliability and confident in the evidence base of their recommendation.

Conclusion

This case highlights the diagnostic challenge of Pott’s puffy tumour in children and the significant risks of delayed diagnosis and treatment. The progression from a seemingly benign preseptal cellulitis to life-threatening intracranial complications, including superior sagittal sinus thrombosis, illustrates the critical importance of early, evidence-based intervention. Furthermore, the case underscores the harm that medical misinformation and parental hesitancy can pose to paediatric patients and the crucial role of healthcare professionals in addressing these factors should they arise. When personal beliefs lead to the refusal of standard therapies or delays in care, the risk of complications rises. Clinicians must maintain a high index of suspicion and proactively manage health literacy in patients and their families, particularly in unwell children, to prevent avoidable complications.