CO12 | A case of diffuse alveolar hemorrhage secondary to post-traumatic fat embolism syndrome
Year: 2025
Type: article
Study design: Case Report
Abstract: Introduction: This case describes a young healthy female with hypoxemic respiratory failure, anemia and fever after a post-traumatic femoral fracture.Description: A young healthy female presented to the emergency room because of a left femoral fracture. 24-hours after surgery, she developed fever, respiratory failure and anemia. Chest angio-CT was negative for pulmonary embolism. After few days the patient had a worsening of anemia and respiratory failure, requiring NIV. A new chest angio-CT was compatible with diffuse alveolar hemorrhage (DAH). Blood cultures and connective tissue serologies were negative. In the hypothesis of fat embolism syndrome (FES), we sought urinary fat, resulted positive. Broncoscopy with bronchoalveolar lavage (BAL) showed an increase in hemorrhagic aliquots (confirming the radiologic pattern of DAH) while citology was notable for abundant lipid-laden macrophage, supporting the diagnosis of FES associated DAH (FEDAH). High-doses methil-prednisolone therapy was started, with a rapid regression of respiratory failure, fever and anemia. A new chest CT was normal. Conclusions: We described a case of FEDAH after a femoral fracture. To date, only few cases of FEDAH are described in literature. Clinical suspicion is based on acute respiratory failure, pulmonary infiltrates, hemoptysis, anemia and fever after long-bone fracture, with a diagnosis of exclusion. Research of urinary fat, a rapid and low-cost test easy available in Emergency Department, may be useful for an early diagnostic assessment. Prognosis is good if supported therapy is started early.
Source: Italian Journal of Medicine
Authors: Vo Van Kha, Tran Thi Huong Ly, Pham Thi Thanh Hoa, Vo Huynh Nhu, Damas Hendriansyah, Nusratuddin Abdullah, Rudy B. Leonardy, Mardiah Tahir, Samrichard Rambulangi, Firdaus Hamid, Filomena Pietrantonio, Vera Kopsaj, Francesco Rosiello, Aurora Tomassoni, Luca Moriconi, Donatella Padua, Kiki Rizki Amelia, Efendi Lukas, Nurbani Bangsawan, Isharyah Sunarno, Retno Budiarti Farid, Sriwijaya Qadar, Rabab H. Elshaikh, Ashok Kumar Sah, Abdelrahman Mohamed Abukanna, Abdulrahman Algarni, Ammar Abdelmola, Hussam Ali Osman, Tagwa Yousif Elsayed Yousif, Elryah I. Ali, Hiba Ali, Ayman Hussein Alfeel, Thanh Long Nguyen, Victor Storm, Lam Toi Phung, Cong Thien Le, Thi Thu Ha Le, Thi Hoa Nguyen, Son Tung Vu, Thien Thang Tran, Minh Hanh Vu, Van Tuan Nguyen, Francesco Ventrella, Anna Belfiore, Antonio Greco, Franco Mastroianni, Salvatore Lenti, Domenico Ruggiero, Michele Cannone, Vincenzo Ostilio Palmieri, Massimo Errico, Giuseppe Mancia, Guido Grassi, Sverre E. Kjeldsen
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4413772327