A case of fat embolism syndrome in juvenile rheumatoid arthritis patient

Kyung Hoon Kim; Ju Kyung Lee; Young Hun Choi; Woo Sun Kim; June Dong Park; Young Yull Koh; Dong In Suh

doi:10.4168/aard.2013.1.1.94

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Kim, Lee, Choi, Kim, Park, Koh, and Suh: A case of fat embolism syndrome in juvenile rheumatoid arthritis patient

Case Report

Allergy, Asthma & Respiratory Disease

Allergy, Asthma & Respiratory Disease 2013; 1(1): 94-97.

Published online: 31 March 2013

DOI: https://doi.org/10.4168/aard.2013.1.1.94

A case of fat embolism syndrome in juvenile rheumatoid arthritis patient

Kyung Hoon Kim¹, Ju Kyung Lee¹, Young Hun Choi², Woo Sun Kim², June Dong Park¹, Young Yull Koh¹, Dong In Suh¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

²Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to: Dong In Suh. Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea. Tel: +82-2-2072-4192, Fax: +82-2-2072-3917, dongins0@snu.ac.kr

Received 22 October 2012 Revised 27 December 2012 Accepted 27 December 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Fat embolism syndrome is a serious complication that can occur after trauma or operation of the limbs. Clinical criteria are used for the diagnosis of fat embolism syndrome and sometimes radiologic findings are helpful. Fat embolism syndrome is known to occur less frequently in children than in adults, but there is an increased risk in children with connective tissue disease. However, there are only a few reported cases of fat embolism syndrome in juvenile rheumatoid arthritis which is the most common connective tissue disease in children. We report a case of fat embolism syndrome diagnosed in a 13-year-old boy with juvenile rheumatoid arthritis, which was treated with corticosteroid.

Keywords: Fat embolism, Juvenile rheumatoid arthritis

Figures and Tables

Fig. 1

Initial chest computed tomographic scan shows ground-glass opacities at the left lower lobe (arrows).

Fig. 2

(A) Chest radiograph obtained 2 days after admission revealed bilateral diffuse haziness. (B) Follow-up chest computed tomographic scans obtained on the same day demonstrate multiple small nodules (arrows) and diffuse ground-glass opacities in both lungs.

Fig. 3

Fundus exam shows multiple white patches in the right fundus with an embolic infarct at the macula.

Fig. 4

Ten days later, nodular and ground-glass opacities on chest computed tomography were completely resolved.

Table 1

Gurd's diagnostic criteria of fat embolism

Fat embolism syndrome=1 major+4 minor+fat macroglobulinemia.

Reproduced from Gurd and Wilson. J Bone Joint Surg Br 1974;56B:408-16, with permission of the British Editorial Society of Bone and Joint Surgery.7)

Table 2

Fat embolism index

Fat embolism syndrome=5 or more score.

Reproduced from Schonfeld et al. Ann Intern Med 1983;99:438-43, with permission of American College of Physicians.2)

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