When the diagnosis is written on the forehead

      An 81 year-old man with a medical history of smoking, mild alchool intake, hypertension and diabetes, presented to the Internal Medicine Unit with 4 cm soft, well demarcated, painless swelling of the forehead which appeared 2 weeks earlier (Panel A, B arrow). He had no definite symptoms of sinusitis. He had no headache, fever or neurologic deficit. He reported weight loss (about 5 Kg) and profound asthenia by at least one month. Laboratory examinations showed increased CRP (31 mg/L), normal white-blood cellcount. Computed tomography of the head revealed unilateral opacification of the left maxillar, ethmoid and frontal sinuses with defects in the frontal bone and spread to subcutaneus tissue other than an erosive aspect within orbital roof (Panel C, D, E). On the basis of these findings, was collected specimen by aspirate of frontal bone abscess. Cultures grew Streptococcus constellatus. The patient was treated with intravenous antibiotic agents for 6 weeks after endoscopic sinus surgery. He remained well with no residual abscess on follow-up obtained 1 month after drainage.
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