Brain Abscess Due to Neglected Tetralogy of Fallot: A Case Report

Abstract

Backgroiund: Tetralogy of Fallot (TOF) is a type of congenital heart disease accounts for about 10% of all congenital cardiac deformities, and is the most common cyanotic lesion after the first year of life. The ideal age for correction of tetralogy of Fallot is still under discussion. Non-cardiac manifestation due to oxygen deficiency has to be aware of in cyanotic patient is brain abscess, because of the right-left shunt in long standing TOF.
 Objectives: To report a case of neglected TOF.
 Case And Discussion: A one-year-old male presented to Murni Teguh Memorial Hospital with the chief complaint of stiffed neck for the past 3 days and got fever for 10 days before admitted, with nausea and vomiting. He was diagnosed with Tetralogy of Fallot through an echocardiography examination when he was 2 months old, but never go through any medical nor surgical treatment. The boy responded to verbal, no eye contact, high grade fever, stiffed neck, Kernig sign and Brudzinski sign was found, and the right extremities were spastic, clubbing finger. On cardiac examination, there was systolic murmur grade ¾ in the left second intercostal space. Echocardiography evaluation revealed dilated RA-RV, no PDA shunt, large mal alignment ventricular septal defect, overriding aorta > 50%, right ventricular hypertrophy, and severe infundibular pulmonary stenosis, consistent with Tetralogy of Fallot. During hospitalization, there were several episodes of seizure and decreased of consciousness, brain CT investigation was done. The abscess was evacuated and a ventriculoperitoneal shunt was performed. One week after the operation, the patient developed abdominal distention, green bile like vomiting, decreased bowel movement and soon muscular defense. From the plain abdominal x-ray and CT revealed peritonitis and intestinal obstruction. An emergency laparotomy was performed, followed by adhesiolysis and jejunostomy due to jejunal perforation. The boy passed away after several episodes of septic shock.
 Conclusions: We would like to emphasis the consequence of the neglected treatment in infant with TOF.