A 12 year old girl presents with a prominent, rapidly enlarging swelling of her forehead for 4 days, in association with a low grade fever. There was no antecedent history of trauma. Close questioning reveals a history of nasal congestion with a clear nasal discharge, and an intermittent frontal headache for 4 months. Her medical, drug and family histories are unremarkable.
WBC: 13,500/mm3 (4,000-11,000) Hb: 11.9 g/dL (11.5 - 15.5) Platelets: 211,000/mm³ (150,000–350,000) C-reactive protein: 24 mg/dL (< 6)
There are bony erosions of the left frontal bone suggestive of osteomyelitis, in association with a 3×1.5 cm subperiosteal abscess, and a 2.1×0.8 cm frontal epidural abscess. Left-sided periorbital cellulitis and pansinusitis is noted.
The cerebrospinal fluid analysis is within normal parameters.
A biopsy will be arranged tomorrow.