A Case Report on a Patient with Tetralogy of Fallot and CNS Tuberculosis

Central nervous system (CNS) tuberculosis (TB) is one of the extrapulmonary manifestations of mycobacterium tuberculosis. Cerebrovascular accidents and cerebral abscesses in children constitute 5 to 18.7% of all cases. Therefore, a child with congenital heart disease (Tetralogy of Fallot) and neurological manifestations consistent with brain abscess and suffered from CNS tuberculosis.
CASE PEPORT: The patients is a 10-year-old boy with Tetralogy of Fallot who underwent ceftriaxone, vancomycin and anticonvulsant treatments with initial suspicion of central nervous system infection and with symptoms of fever, seizures and decreased consciousness. Due to observation of cerebral edema and several lesions in brain parenchyma in CT scans in the form of abscess, corticosteroid and metronidazole was added to the treatment process and the patient underwent cerebrospinal fluid analysis. Considering low sugar of cerebrospinal fluid, improved brain image and at the same time, lack of clinical recovery, we suspected mycobacterium tuberculosis. Therefore, the cerebrospinal fluid PCR was sent and the experimental anti-tuberculosis treatment started. Finally, the result was positive in terms of mycobacterium and anti-tuberculosis treatment continued.
Tuberculosis as the cause of disease manifestations in endemic areas should always be taken into consideration. To justify patient symptoms with more common causes, one should not discard other diagnoses; because early diagnosis of CNS tuberculosis prevents certain death.