Late presentation of TAPVC with multiple cerebral abscesses

Area of Science:

• Cardiology
• Neurology
• Pediatric Cardiology

Background:

• Congenital heart disease (CHD) often presents in infancy or childhood.
• Total anomalous pulmonary venous connection (TAPVC) is a rare cyanotic CHD where pulmonary veins do not connect normally to the left atrium.
• Adult presentation of TAPVC is uncommon, with varied clinical manifestations.

Observation:

• A 24-year-old male presented with acute neurological symptoms: fever, headache, vomiting, and seizures.
• Initial diagnostic workup revealed cerebral abscesses as the primary clinical issue.
• Further cardiac evaluation identified non-obstructive supracardiac TAPVC as the underlying etiology.

Findings:

• The patient had no prior history of cardiac symptoms, making the adult diagnosis of TAPVC unexpected.
• Cerebral abscesses are an unusual primary manifestation of TAPVC.
• This case underscores the potential for severe, atypical presentations of CHD in adulthood.

Implications:

• Highlights the importance of considering congenital heart disease in adults presenting with unexplained neurological deficits.
• Suggests that TAPVC, though rare, can manifest late in life with severe complications.
• Emphasizes the need for comprehensive diagnostic approaches in complex adult cases.