A 6-year-old boy presented after waking up with swelling of his forehead and bilateral eyelids. He had not experienced recent falls, trauma, or travel. The patient had not been outdoors in the previous 24 hours, but it was unclear whether he had any insect bites. He had a history of nonverbal autism.

Physical examination confirmed swelling in the center of his forehead that was soft, nonfluctuant, mildly tender, and approximately 10 cm in diameter (Figure 1). The area was not pruritic and showed no indication of injury or insect bite. The patient had significant symmetrical periorbital edema but no discharge or erythema around the eyes. His extraocular movements were intact, and he had no proptosis, fever, shortness of breath, or rhinorrhea.

QUESTION

Based on the patient's history and physical examination, which one of the following is the most likely diagnosis?

• A. Allergic reaction to insect bite.

• B. Bacterial rhinosinusitis.

• C. Blunt forehead trauma.

• D. Cellulitis.

• E. Pott puffy tumor.

DISCUSSION