Fat embolism syndrome after humerus and pelvis fracture complicated by acute kidney injury requiring blood purification: a case report and literature review

Renal Replacement Therapy

Case Report

Takahiro Koga¹  Yasuhiro Myojo¹  Akikatsu Nakashima²  Takuya Suda²  Hiroshi Fujii²  Keita Asakura²  Makoto Horita²  Ryo Nishioka³  Mitsuhiro Kawano³ 

[1] Department of Emergency and Critical Care, Ishikawa Prefectural Central Hospital, Kanazawa, Japan;Department of Nephrology and Rheumatology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, 920-8530, Kanazawa, Ishikawa, Japan;Department of Rheumatology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan;

关键词: Fat embolism syndrome;    Acute kidney injury;    Hemodialysis;    Continuous hemodiafiltration;    Continuous renal replacement therapy;    Pulmonary hypertension;    Right heart failure;    Susceptibility-weighted imaging;    Steroid;    Methylprednisolone;    Hemolytic anemia;    Thrombotic microangiopathy;    Disseminated intravascular coagulation;    Hemolytic uremic syndrome;   

DOI  :  10.1186/s41100-023-00504-0

 received in 2023-02-02, accepted in 2023-09-27,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundFat embolism syndrome (FES) is a rare syndrome that typically occurs 12–72 h after long bone or pelvic fractures with a classic triad of respiratory distress, neurologic changes, and petechial rash. Although Gurd’s criteria for FES include anuria or oliguria, the mechanism of acute kidney injury (AKI) remain unknown. Here, we present a case of FES complicated by AKI that required blood purification.Case presentationA 79-year-old woman was admitted to our hospital because of a right humerus and pelvic fracture caused by a traffic accident. On the second day of hospitalization, she developed impaired consciousness, respiratory failure, and disseminated intravascular coagulation (DIC). Chest radiography revealed bilateral diffuse alveolar infiltration. Brain magnetic resonance imaging revealed diffuse high signal intensity on diffusion-weighted imaging and diffuse low signal intensity on susceptibility-weighted imaging in the cerebral and cerebellar regions. The diagnosis of FES was confirmed and the patient was treated with methylprednisolone (40 mg/day) and ulinastatin. On the third day of hospitalization, she was admitted to our department because of AKI with oliguria. Although echocardiography showed an elevated right ventricular artery systolic pressure suggestive of pulmonary hypertension (PH), pulmonary congestion was initially considered on chest imaging, and hemodialysis and rapid ultrafiltration were initiated. However, she developed hypovolemic shock and treatment was switched to continuous hemodiafiltration and slow ultrafiltration. Thereafter, her consciousness, hypoxemia, DIC and PH completely improved. She was weaned from blood purification therapy on the 29th day of hospitalization. She had hemolytic anemia that might have been caused by thrombotic microangiopathy (TMA), but it resolved without plasmapheresis. On the 51st day of hospitalization, the patient was transferred to another hospital for rehabilitation.ConclusionsFES can be complicated by AKI. In this case, DIC, which was difficult to differentiate from TMA, and/or renal congestion were considered to be a cause of AKI. Chest radiographs of FES may be indistinguishable from pulmonary congestion. In our case, chest radiography showed bilateral diffuse alveolar infiltrates which was not indicative of pulmonary congestion but pulmonary involvement of FES. FES is associated with PH, which may lead to right heart failure. Therefore, the patient could have developed hypovolemic shock due to hemodialysis and rapid ultrafiltration. Clinicians should pay attention to the hemodynamics when blood purification for FES is performed.

【 授权许可】

CC BY   
© The Japanese Society for Dialysis Therapy and BioMed Central Ltd. 2023

【 图 表 】

Fig. 1

Fig. 2

Fig. 5

Fig. 2

Fig. 2