Unusual presentation of cyanotic congenital heart disease in adult

A case report regarding cyanotic congenital heart disease - tetralogy of fallot presenting in the 4th decade of life, the patient is surviving till the age of 35 years without any surgical intervention. The important clinical manifestations were gingival and oral mucosal bleeding, fever and frequent chest infections. Interestingly in patients with tetralogy of fallot there is a seeming paradox between abnormal haemostasis on the one hand and a thrombotic predisposition in specific vascular beds on the other. This case report highlights a hemorrhagic tendency encountered in a case of an adult with tetralogy of fallot.Further investigations and imaging showed bronchiectasis of the left lower lobe along with bilateral fibrotic changes in both lungs which has been rarely reported in patients with oligemic lung fields so far. Uncorrected tetralogy of fallot presenting in the 4th decade of life is an uncommon entity, the development of bleeding tendencies and an altered coagulation profile with abnormalities in both the extrinsic and intrinsic coagulation pathway along with thrombocytopenia has been rarely reported Finally the association of tetralogy of fallot with brochiectasis is still very rare.