Tetralogy of Fallot (TOF) carries a higher risk for infective endocarditis (IE) due to associate multiple cardiac lesions. The incidence of IE in operated TOF patients either by corrective or palliative surgery is high (around 18%), however small (around 4%) in non-corrected TOF. Most reported cases of infective endocarditis complicating TOF have been in adults, reports of central embolization complicating infective endocarditis is also rare in African literatures, especially in children with TOF. We therefore report a case of gangrene of the left forearm from central embolization in a 14-month child with TOF who had septicaemia with infective endocarditis and acute renal failure.