A fatal case of brain abscess in a child with tetralogy of fallot: a rare and devastating complication

Brain abscess is a rare but severe complication in children with cyanotic congenital heart disease, particularly tetralogy of fallot (TOF). Due to the risk of paradoxical embolism and infective endocarditis, these patients are highly susceptible to central nervous system infections, which can rapidly progress to life-threatening complications. We report the case of a 6-year-old male child with a known diagnosis of TOF who presented with persistent high-grade fever, headache, and neurological deterioration. Initial investigations revealed leukocytosis, thrombocytopenia, and positive blood cultures for methicillin-resistant Staphylococcus aureus . Imaging confirmed a ruptured brain abscess with resultant ventriculitis and hydrocephalus. Despite emergency neurosurgical intervention, including external ventricular drainage and abscess evacuation, the child developed worsening septic shock, disseminated intravascular coagulation, and refractory seizures. Despite intensive medical and surgical management, the patient succumbed to multiorgan failure. This case underscores the importance of early recognition of neurological complications in cyanotic congenital heart disease. Delayed diagnosis and the aggressive nature of sepsis in immunocompromised children significantly increase mortality. A multidisciplinary approach involving early imaging, targeted antibiotic therapy, and timely surgical intervention is crucial for improving outcomes in high-risk cases.