Headache of a diagnosis: frontotemporal pain and inflammation associated with osteolysis

A 62-year-old woman presented with left frontotemporal pain, scalp tenderness and raised levels of inflammatory markers. Temporal arteritis was considered likely, and symptoms resolved with prednisone therapy. This delayed diagnostic bone biopsy until a soft tissue abscess formed, and Pott's puffy tumour associated with Prevotella osteomyelitis of the frontal bone was diagnosed. This case highlights the value of early histopathological examination, and is a reminder of a condition seen frequently in the pre-antibiotic era.

A 62-year-old woman was referred with a 6-month history of spontaneous left frontotemporal scalp pain. Initially, the pain was associated with a soft swelling over the scalp and resolved within 6 weeks. It recurred 4 months later, without associated swelling, localised to the left frontal region and became progressively more severe, disturbing the patient’s sleep. She remained systemically well and had no history of fever, sinusitis, dental infection or diabetes mellitus.