Tetralogy of Fallot complicated by multiple cerebral abscesses in a child: a case report

• Published in: Journal of medical case reports Vol. 18; no. 1; p. 183
• Main Authors: Kamabu, Larrey Kasereka, Sikakulya, Franck Katembo, Kataka, Louange Maha, Vivalya, Bives Nzanzu Mutume, Lekuya, Hervé Monka, Obiga, Doomwin Oscar Deogratius, Sekabunga, Juliet Nalwanga, Bbosa, Godfrey S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28-03-2024; BioMed Central; BMC
• Subjects: Abscess; Abscesses; And medical management; Anti-Bacterial Agents - therapeutic use; Antibiotics; Brain Abscess - complications; Brain Abscess - diagnostic imaging; Cardiovascular disease; Care and treatment; Case Report; Case reports; Ceftriaxone - therapeutic use; Child; Child, Preschool; Children & youth; Comparative analysis; Congenital diseases; Consciousness; CT imaging; Cyanosis - drug therapy; Defects; Edema; Emergency medical care; Genetic disorders; Heart; Heart Defects, Congenital - complications; Heart diseases; Humans; Hydrocephalus; Interdisciplinary aspects; Male; Medical imaging; Medical research; Medicine, Experimental; Metronidazole; Multiple cerebral abscesses; Patients; Pediatrics; Surgery; Surgical drainage; Tetralogy of Fallot; Tetralogy of Fallot - complications; Tetralogy of Fallot - diagnostic imaging; Tetralogy of Fallot - surgery; Tinidazole; Multiple cerebral abscesses; Tetralogy of Fallot; Child; Surgical drainage; And medical management
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-024-04451-0

Brain abscesses are rare but potentially fatal condition and can be associated with cyanotic congenital heart disease of which 5-18.7% of these patients that develop cerebral abscess commonly have tetralogy of Fallot (TOF).
We report a case of 3-year-old Muganda male that presented with convulsions, cyanosis and difficulty in breathing. The patient had a combination intervention of medical treatment and surgical drainage of the abscess. Post-operative Computerized tomography scan images and pre-operative brain Computerized tomography scans were compared. The multiple rings enhancing lesions were reduced in number and sizes. The largest measured ring was 44 × 22.5×16mm compared to the previous; 42 × 41×36mm. The mass effect had reduced from 16 mm to 7.5 mm. The periventricular hypodensities persisted. Findings showed radiological improvement with residual abscesses, subacute subdural hematoma and pneumocranium. The patient was treated with intravenous ceftriaxone 1 g OD for six weeks and he showed marked improvement and was discharged home after 3 months.
A comprehensive strategy involving medications, surgical drainage, and early neurosurgical consultation is vital in treating brain abscesses in uncorrected TOF. Early identification of the pathogen, appropriate antibiotic therapy, and vigilant follow-up through clinical assessments and imaging are crucial, potentially spanning a 4-8-week treatment.