[Fat embolism syndrome: a condition unfamiliar to the dermatologist].


To the Editor: The fat embolism syndrome was described by Zenker in 1861,1 although the triad of confusional state, dyspnea, and petechiae had already been mentioned in the German literature by Von Bergman.2 Despite being described more than 100 years ago, the diagnosis and specific treatment of this syndrome are still a subject of debate. With the 2 cases presented here, we aim to draw attention to a dermatological disorder which is widely discussed in the medical and surgical literature but which is unfamiliar to the dermatologist. The first patient was an 18-year-old man who had suffered a motorbike accident and presented a major lung contusion and multiple long-bone fractures (Figure 1). The fractures were immobilized with plaster casts and the patient was admitted to hospital for routine surgery. He was asymptomatic for 48 hours, but before the surgical intervention, small papules a few millimeters in diameter appeared; they were of reddish color, did not blanch on pressure, and were distributed over the anterior aspect of the thorax, base of the neck, and conjunctivae, and in the axillas (Figure 2). This was followed by a rapid onset of neurological signs, consisting of temporospatial disorientation and clouding of consciousness, and acute respiratory failure. The chest radiograph showed bilateral opacities in both lung fields that were not present at the time of admission. No relevant findings except for mild thrombocytopenia were reported in the additional studies performed—complete blood count, biochemistry, coagulation, urinary sediment, and cerebral computed tomography (CT). Despite intensive supportive measures, the patient died a few hours later. The second patient was a 27-year-old man, also victim of a motorcycle accident. He presented fractures of the right femur and left radius and ulna, and underwent surgical osteosynthesis. After being asymptomatic for 48 hours, he developed fever of up to 39°C associated with psychomotor agitation, severe acute respiratory failure, and pinpoint petechial lesions in the axillas and around the base of the neck. The complete blood count revealed anemia of 9.5 g/dL and thrombocytopenia of 98 ! 109/L; biochemistry and coagulation were normal. Lipiduria was observed in the urinary sediment. Cerebral CT was normal and the chest radiograph showed multiple, peripheral, focal opacities in both lung fields. The clinical course was favorable and the patient was discharged from intensive care after 10 days and from the hospital 2 weeks later. Fat embolism occurs in patients with long-bone

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@article{HernndezBel2009FatES, title={[Fat embolism syndrome: a condition unfamiliar to the dermatologist].}, author={Pablo Hern{\'a}ndez-Bel and J L{\'o}pez and E Rodr{\'i}guez-Vellando and Beatriz Collado and Isabel Febrer and V{\'i}ctor Alegre}, journal={Actas dermo-sifiliográficas}, year={2009}, volume={100 3}, pages={235-6} }