CO12 | A case of diffuse alveolar hemorrhage secondary to post-traumatic fat embolism syndrome

F.M. Farina, G. Meli, M. Puglisi, A. Buonacera, C.M. Giraffa, P.V. Noto | UOSD Medicina e Chirurgia di accettazione e di urgenza, Ospedale San Marco di Catania, Italy

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.