FATAL FAT-EMBOLISM SYNDROME AFTER NUMEROUS VERTEBRAL BODY COMPRESSIONFRACTURES IN A LUNG-TRANSPLANT RECIPIENT

The fat embolism syndrome is an uncommon clinical disorder that typica lly occurs as a complication of severe trauma. We report the case of a 60-year-old single-lung transplant recipient who died of massive fat emboli. Before lung transplantation, the patient had been treated with corticosteroids for at least 1 year because of chronic obstructive pu lmonary disease caused by centrilobular emphysema and asthmatic bronch itis. After receiving his lung transplant, he was treated with triple- drug immunosuppression, which included 25 mg of prednisone per day. He was discharged from the hospital 2 months after transplantation only to be readmitted 2 weeks later with cytomegalovirus pneumonia, from wh ich he recovered. Concomitantly, he had new lumbar compression fractur es with severe back pain and lost approximately 3 cm in height during a 3-week period. On the eleventh day after hospital readmission, he su ddenly had a ''sepsis-like'' illness without a known infectious cause, numerous petechiae and ecchymoses, marked pulmonary edema with worsen ing diffuse pulmonary infiltrates, profound hypoxemia, decreased menta tion, and mild thrombocytopenia. He died 3 days later. With the except ion of a positive sputum culture for cytomegalovirus, all cultures wer e negative. The postmortem examination showed severe osteoporosis, mul tiple vertebral compression fractures, and widespread massive fat embo li. This is the first reported case of fat emboli as the cause of deat h in a lung transplant recipient, and the case suggests that the fat e mbolism syndrome should be considered in the differential diagnosis of a sepsis-like illness in patients who have received steroids during a long period, particularly in the setting of vertebral compression fra ctures.