Atypical presentation of fat embolism syndrome: A case report

We present a case report of fat embolism syndrome in the Trauma Intensive Care Unit with an atypical presentation. A 21-year-old male patient was admitted with multiple fractures after a motorcycle accident. Shortly after the debridement of the open fracture and external fixation of the bones, the patient presented with hypoxemia, tachypnea, fever, and tachycardia. There were no neurologic abnormalities and no petechial rash. Supportive care, including mechanical ventilation, was required. Initial chest angiotomography did not detect pulmonary thromboembolism. There were discrete bilateral consolidations in the lung bases - no bacterial or viral infection findings, including a negative COVID-19 test. Computed tomography was repeated after 5 days, evidenced by bilateral well-demarcated ground glass opacities. Our case presented an atypical presentation of fat embolism syndrome, without classical signs and symptoms, such as neurologic abnormalities and petechial rash. In this context, other differential diagnoses were considered, since the clinical manifestations of fat embolism are non-specific, and often are seen in other post-traumatic conditions. This case highlights the diagnostic challenges of fat embolism syndrome in the Intensive Care Unit. Atypical presentation must be taken into consideration when treating high-risk patients.