A 3-year-old boy, who initially presented with breathing difficulties, fever, and weakness on his left side, was diagnosed with encephalitis at one month old after continuous crying and irritability. Following antibiotic treatment, he fully recovered. However, at the age of 2, he was referred to a university hospital due to a variety of symptoms, including rapid breathing, cyanosis, and neurological issues. Diagnostic tests confirmed Tetralogy of Fallot, characterized by a boot-shaped heart, a systolic crescendo-decrescendo murmur, and CT scan revealed subacute right hemisphere infarction without signs of herniation, within the context of corticocortical subcortical atrophy. Concurrently, elevated inflammatory markers, lymphocytosis, and a positive spinal tap for elevated immunoglobulins raised concerns for Rasmussen encephalitis. Treatment involved intravenous fluids, antibiotics, and NSAIDs.

Despite medical intervention, the patient continued to experience persistent left-sided hemiparesis and right facial weakness at the age of 3. Neurological assessments indicated a right pyramidal syndrome affecting the right hemisphere, likely due to septic emboli from infective endocarditis triggering an autoimmune process. Hemispherectomy and cardiac surgery were postponed. Despite multidisciplinary care, the patient's condition deteriorated rapidly, leading to his death within a week.