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The Case of a 15-year-old Adolescent with Cerebral and Pulmonary Fat Embolism Syndrome without Dermatologic Involvement

Objectives: Fat embolism syndrome is rare and fatal and diagnosed with the triad of acute respiratory failure, neurological disorder and mucocutaneous petechiae (1). Neurologically, cerebral stroke, convulsions, motor deficit and diffuse brain damage can be seen (2, 3). In this study, we aim at presenting the case of a 15-year-old adolescent with respiratory and neurological but without dermatological involvement. Case: A 15-year-old male adolescent presented with respiratory distress. The patient's heart rate was 120/min, respiratory rate was 60/min, SpO2 in room air was 40, and the blood pressure was 90/60 mmHg. On the patient’s chest X-ray, alveolar opacity and consolidations with bilateral tendency to coalesce (figure 1a), diffuse alveolar damage pattern as ground-glass areas with diffuse bilateral convergence tendency in the lung parenchyma, enlargement in the pulmonary trunk (figure 1b and 1c) were observed in pulmonary CT angiography and femoral distal fracture line (figure 1d). Diffusion restriction of corpus callosum (figure 2) was observed in the cranial MRI of the patient with severe headache. Considering fat embolism syndrome, low molecular weight heparin and methylprednisolone were started. The patient did not develop motor deficit and he was discharged.

Conclusion:

Lack of a common guideline in the treatment of fat embolism may challenge clinicians. Some studies suggest that lipase-activating heparin should be used, but others oppose it due to the risk of bleeding (3, 4). However, corticosteroids may be beneficial (5). Therefore, urgent experimental and clinical studies should be performed to reduce mortality and morbidity in this syndrome.
Keywords: adolescent, corpus callosum, diffusion restriction, fat embolism syndrome, pulmonary embolism