Allergy Asthma Respir Dis.  2013 Mar;1(1):94-97. 10.4168/aard.2013.1.1.94.

A case of fat embolism syndrome in juvenile rheumatoid arthritis patient

• Kim KH
• Lee JK
• Choi YH
• Kim WS
• Park JD
• Koh YY
• Suh DI

• KMID: 2263067
• DOI: http://doi.org/10.4168/aard.2013.1.1.94

Abstract

Fat embolism syndrome is a serious complication that can occur after trauma or operation of the limbs. Clinical criteria are used for the diagnosis of fat embolism syndrome and sometimes radiologic findings are helpful. Fat embolism syndrome is known to occur less frequently in children than in adults, but there is an increased risk in children with connective tissue disease. However, there are only a few reported cases of fat embolism syndrome in juvenile rheumatoid arthritis which is the most common connective tissue disease in children. We report a case of fat embolism syndrome diagnosed in a 13-year-old boy with juvenile rheumatoid arthritis, which was treated with corticosteroid.

Keyword

Fat embolism; Juvenile rheumatoid arthritis

MeSH Terms

Adult
Arthritis, Juvenile Rheumatoid
Child
Connective Tissue Diseases
Embolism, Fat
Extremities
Humans

Figure

• 

  Fig. 1 Initial chest computed tomographic scan shows ground-glass opacities at the left lower lobe (arrows).

• 

  Fig. 2 (A) Chest radiograph obtained 2 days after admission revealed bilateral diffuse haziness. (B) Follow-up chest computed tomographic scans obtained on the same day demonstrate multiple small nodules (arrows) and diffuse ground-glass opacities in both lungs.

• 

  Fig. 3 Fundus exam shows multiple white patches in the right fundus with an embolic infarct at the macula.

• 

  Fig. 4 Ten days later, nodular and ground-glass opacities on chest computed tomography were completely resolved.

Reference

1. Johnson MJ, Lucas GL. Fat embolism syndrome. Orthopedics. 1996. 19:41–48.

2. Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, et al. Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients. Ann Intern Med. 1983. 99:438–443.

3. Gossling HR, Pellegrini VD Jr. Fat embolism syndrome: a review of the pathophysiology and physiological basis of treatment. Clin Orthop Relat Res. 1982. 165:68–82.

4. Drummond DS, Salter RB, Boone J. Fat embolism in children: its frequency and relationships to collagen disease. Can Med Assoc J. 1969. 101:200–203.

5. Carlson DS, Pfadt E. Fat embolism syndrome. Nursing. 2011. 41:72.

6. Akhtar S. Fat embolism. Anesthesiol Clin. 2009. 27:533–550.

7. Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br. 1974. 56B:408–416.

8. Talbot M, Schemitsch EH. Fat embolism syndrome: history, definition, epidemiology. Injury. 2006. 37:Suppl 4. S3–S7.

9. Malagari K, Economopoulos N, Stoupis C, Daniil Z, Papiris S, Muller NL, et al. High-resolution CT findings in mild pulmonary fat embolism. Chest. 2003. 123:1196–1201.

10. Lindeque BG, Schoeman HS, Dommisse GF, Boeyens MC, Vlok AL. Fat embolism and the fat embolism syndrome. A double-blind therapeutic study. J Bone Joint Surg Br. 1987. 69:128–131.

11. Kubota T, Ebina T, Tonosaki M, Ishihara H, Matsuki A. Rapid improvement of respiratory symptoms associated with fat embolism by high-dose methylpredonisolone: a case report. J Anesth. 2003. 17:186–189.

12. Rabinovich CE. Pulmonary complications of childhood rheumatic disease. Paediatr Respir Rev. 2012. 13:29–36.

13. Athreya BH, Doughty RA, Bookspan M, Schumacher HR, Sewell EM, Chatten J. Pulmonary manifestations of juvenile rheumatoid arthritis. A report of eight cases and review. Clin Chest Med. 1980. 1:361–374.

14. Moon JM, So JI, Kim YK, Ryoo JH, Heo T, Seo JJ, et al. Post-traumatic cerebral fat embolism. J Korean Soc Emerg Med. 2001. 12:170–175.

15. Choi ES, Kim YM, Kim DS, Shon HC, Park KJ, Jeon JM. Fat embolism in a patient with multiple fractures of cancellous bones: a case report. J Korean Fract Soc. 2005. 18:202–204.

16. Park JH, Lim BC. Pathophysiology-based Interpretation of magnetic resonance imaging and management of cerebral fat embolism: case report and review of literature. J Korean Soc Magn Reson Med. 2010. 14:69–73.