A case of traumatic fat embolism syndrome
Fat embolism syndrome (FES) is a systemic inflammatory cascade affecting multiple organ systems occurring after trauma, orthopedic procedures and rarely in non-traumatic patients causing high morbidity and mortality.

Published in the Journal of Neurology Research, the authors report a case of traumatic fat embolism, treated successfully with supportive management. Diagnosis of FES needs high index of suspicion and use of clinical criteria along with imaging.

A 68-year-old female was brought to the emergency room after a fall while walking in the living room. The patient suffered fracture of right inferior pubic ramus and was stable hemodynamically, without any alteration of sensorium. Chest radiography and arterial blood gas analysis were normal. Patient was opted for conservative management in view of comorbidities and option chosen by relatives.

24 hours after admission, the patient developed decreased level of consciousness, hypotension and shortness of breath, manifested as tachycardia (> 120/min), dyspnea, and hypoxemia (PO2: 70 mm Hg, PaCO2: 39 mm Hg, pH 7.40).

MRI brain with head and neck angiography showed multiple small focal acute infarcts in bilateral subcortical and paraventricular regions of fronto-parietal lobes involving the corona radiata and centrum semiovale, suggestive of fat embolism.

A repeat chest radiograph revealed bilateral perihilar fullness and features of ARDS. Based on the patient’s oxygen requirement and continued tachycardia and tachypnea, D-dimer assay was done and two values were found to be abnormal (1,600 and 1,750 µmg/L).

The patient was administered heparin and furosemide. Approximately 4 h later, the patient’s oxygen saturations improved, from 79% to 91% on 5 L of oxygen. Her pulse returned to 104 beats per minute, and her systolic blood pressure stabilized in the range of 110- 125 mm Hg.

Patient improved over a period of next 36 h with decreased need of oxygen. A review of her symptoms indicated the patient met five of Gurd and Wilson’s criteria for FES, including petechiae, hypoxemia, pyrexia, tachycardia, and relative thrombocytopenia.

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