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Tetralogy of Fallot complicated by multiple cerebral abscesses in a child: a case report
Larrey Kasereka Kamabu1,2, Franck Katembo Sikakulya3,4, Louange Maha Kataka3
1Department of Surgery, Neurosurgery, College of Health Medicine, Makerere University, Mulago Upper Hill, Kampala, Uganda. kamabularry@gmail.com.
Introduction:
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).
Case Presentation:
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.
Conclusion:
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.
Insights
Brain abscesses in patients with Tetralogy of Fallot (TOF) require prompt medical and surgical treatment. This case highlights the importance of a comprehensive strategy for improved outcomes in these rare but serious conditions.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Cardiology
Background:
- Brain abscesses are rare, life-threatening complications, particularly in children with cyanotic congenital heart disease.
- Tetralogy of Fallot (TOF) is frequently associated with cerebral abscesses, occurring in 5-18.7% of affected patients.
Observation:
- A 3-year-old male with TOF presented with seizures, cyanosis, and respiratory distress.
- The patient underwent a combined medical and surgical intervention for a brain abscess.
Findings:
- Post-treatment imaging revealed a significant reduction in the number and size of ring-enhancing lesions and decreased mass effect.
- Radiological improvement was noted, with residual abscesses, subdural hematoma, and pneumocranium.
- The patient received intravenous ceftriaxone for six weeks, showing marked improvement and discharge after 3 months.
Implications:
- Effective management of brain abscesses in uncorrected TOF necessitates a multidisciplinary approach, including antibiotics, surgical drainage, and early neurosurgical consultation.
- Early pathogen identification, tailored antibiotic therapy, and close clinical and imaging follow-up (4-8 weeks) are critical for successful treatment.
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