Verly Hosea, Hadia Angriani, Urfianty
Background: Brain abscess is a focal area of necrosis with a surrounding membrane within the brain parenchyma, usually resulting from an infectious process or rarely from a traumatic process. The incidence rate was 1.3/100,000 person-years, 1.9 in males and 0.6 in females. Cyanotic Congenital Heart Disease (cCHD) is characterized by intracardiac right-to-left shunting of unsaturated blood and its distribution into the systemic circulation resulting in arterial hypoxemia. Patients with cCHD develop repeated brain abscesses secondary to polycythemia-induced cerebral infarcts; further, poor host immunity and bypass of lung phagocytosis are contributory factors. cCHD, especially Tetrology of Fallot (TOF), accounts for nearly 13-70% of all brain abscess cases. Management of a usual brain abscess includes either aspiration by various techniques and antibiotics or craniotomy and excision in abscesses unresponsive to antibiotics. Objective: To report a case multiple brain abscess in cyanotic congenital heart disease in a 13 years old. Case: A 13 years old boy was admitted with headache since 1 month before admission. He had a non projectile vomiting since 2 weeks. He had history of dyspnea with cyanosis noticed since he was 1,5 years old especially during feeding and exercise but he never to take any treatment. Physical examination revealed an undernourish, cyanosis, clubbing fingers, heart murmur. There was no mental status and neurologic deficits. On 45th days of hospitalized, we do drainage abscess surgery after no improvement with antibiotics and antiamoebic. Radiological examination with CT- Head Scan revealed Multiple Brain Abscess frontalis, parietalis, and paraventrikel lateralis regio. Thorax x-ray revealed a cardiomegaly with L-R shunt. Echocardiography revealed tetralogy of fallot. Laboratory examination revealed haemoconcentration and blood smear showed signs of infection.. Patient was treated with antibiotics and antiamoebic, propranolol, underwent drainage abscess with cranioplasty. Culture abscess was no growth of bacteria. Conclusion: A case of multiple brain abscess in cyanotic congenital heart disease in 13 years old boy has been reported. The diagnosis was based on history taking, physical examination, laboratory and radiological finding. The therapy was drainage abscess surgery, antibiotics, antiamoebic. The prognosis in this patients is dubia ad malam.