Fat Embolism Syndrome Following Elective Orthopedic Surgery in a Patient With Duchenne Muscular Dystrophy

Duchenne muscular dystrophy (DMD) is associated with substantial perioperative morbidity due to progressive cardiopulmonary disease and altered muscle physiology; however, fat embolism syndrome (FES) is rarely considered during perioperative risk assessment for this population. We report the case of an 11-year-old boy with genetically confirmed DMD, chronic corticosteroid therapy, severe osteopenia, and a patent foramen ovale who developed fulminant multisystem FES following elective bilateral Achilles tendon lengthening. Despite guideline-concordant anesthetic management using total IV anesthesia with avoidance of triggering agents, the patient developed acute hypoxemic respiratory failure and progressive encephalopathy within hours of surgery, followed by seizures, retinal microemboli, and diffuse pulmonary infiltrates. Extensive evaluation excluded infectious, inflammatory, and primary vascular etiologies, and the patient met multiple major and minor Gurd's criteria for FES. This case highlights that children with DMD may be uniquely susceptible to FES even after seemingly low-risk elective orthopedic procedures, independent of anesthetic technique or intraoperative instability. It underscores the need for heightened postoperative vigilance and disease-specific perioperative risk stratification in this vulnerable population.