A 6-year-old male child was brought to the emergency department by his parents with a chief complaint of a painful, progressively enlarging swelling on the forehead for the past five days. The swelling was associated with redness, warmth, tenderness, and low-grade fever. The child had no history of trauma, insect bite, or recent infection. On physical examination, the swelling measured approximately 4 x 3 cm in diameter, located in the mid-forehead region, slightly above the glabella. The overlying skin appeared erythematous, tense, and glistening. Fluctuation test was positive, indicating the presence of fluid. Initial Evaluation and Diagnosis: The child was afebrile at presentation but reported localized pain with mild systemic discomfort.
There was no history of seizures, vomiting, or altered level of consciousness. Neurological examination was unremarkable. A presumptive diagnosis of infected sebaceous cyst or subcutaneous abscess was made based on clinical findings. Baseline investigations including CBC revealed leukocytosis (WBC count: 15,000/mm³) with neutrophilic predominance, suggesting active infection. No other systemic abnormality was found. Emergency Management: Informed consent was obtained from the parents after explaining the need for an emergency abscess drainage procedure. Under sterile conditions and local anesthesia (2% lidocaine infiltration), a linear incision was made over the most fluctuant part of the swelling. Approximately 8–10 mL of thick yellowish-green purulent material was drained. A moderate amount of necrotic tissue was found in the abscess cavity, which was gently debrided. The pus was collected and sent for culture and sensitivity testing. The cavity was thoroughly irrigated with normal saline and diluted povidone-iodine solution. A small Penrose drain was inserted and secured to allow continuous drainage, and a sterile dressing was applied.
