OBJECTIVE: Cerebral abscess is a rare, but often fatal focal intracranial infection. The mortality rate for cerebral abscesses ranges from 4-10%, and prompt, accurate treatment is required to improve quality of life and prevent death. Cyanotic congenital heart disease is one of the most important predisposing factors in children 4-7 years old. Several prognostic factors contribute to a poor prognosis, including loss of consciousness, seizure, focal neurological deficits, meningismus, high fever (>38.5º C), and leukocytosis (> 20.000/mm3). This case report aims to determine the prognosis and describe the outcome of cerebral abscess in pediatric patient with Tetralogy of Fallot.
CASE: A six-year-old boy with Tetralogy of Fallot experienced headache, fever, and weakness on the left side of the body for 7 days prior to admission. There was no loss of consciousness or seizure. Chest X-Ray showed a boot-shaped cardiac appearance, and echocardiography showed right ventricle hypertrophy, ventricular septal defect, overriding aorta and pulmonary stenosis (Tetralogy of Fallot) with a thrombus in the left ventricle. A head CT scan was performed, showing a relatively thick-walled cystic mass with perifocal edema in the right temporal area, which indicates a cerebral abscess. The patient was treated with a two-week course of Ceftriaxone and Metronidazole and was reevaluated. Surgical drainage (Burr hole drainage) of the abscess was determined to be necessary due to the abscess's large size (? 2.5 cm) and the lack of response to antibiotic therapy. The surgery was followed by an administration of Meropenem for two weeks.
CONCLUSION: The prognosis of a cerebral abscess with Tetralogy of Fallot according to the prognostic factors was dubia ad bonam, as demonstrated in this case, where a focal neurological deficit was found without the occurrence of other prognostic factors.