Day J D, Walden S M, Stuart S R, Hutchins G M, Hruban R H
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Md.
J Heart Lung Transplant. 1994 Sep-Oct;13(5):785-90.
The fat embolism syndrome is an uncommon clinical disorder that typically 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 pulmonary disease caused by centrilobular emphysema and asthmatic bronchitis. 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 which he recovered. Concomitantly, he had new lumbar compression fractures with severe back pain and lost approximately 3 cm in height during a 3-week period. On the eleventh day after hospital readmission, he suddenly had a "sepsis-like" illness without a known infectious cause, numerous petechiae and ecchymoses, marked pulmonary edema with worsening diffuse pulmonary infiltrates, profound hypoxemia, decreased mentation, and mild thrombocytopenia. He died 3 days later. With the exception of a positive sputum culture for cytomegalovirus, all cultures were negative. The postmortem examination showed severe osteoporosis, multiple vertebral compression fractures, and widespread massive fat emboli. This is the first reported case of fat emboli as the cause of death in a lung transplant recipient, and the case suggests that the fat embolism 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 fractures.
脂肪栓塞综合征是一种罕见的临床病症，通常作为严重创伤的并发症出现。我们报告一例60岁单肺移植受者因大量脂肪栓子死亡的病例。在肺移植前，由于小叶中心型肺气肿和哮喘性支气管炎引起的慢性阻塞性肺疾病，该患者已接受皮质类固醇治疗至少1年。接受肺移植后，他接受三联药物免疫抑制治疗，其中包括每天25毫克泼尼松。移植后2个月他出院，但2周后因巨细胞病毒肺炎再次入院，并从中康复。与此同时，他出现新的腰椎压缩性骨折并伴有严重背痛，在3周内身高下降了约3厘米。再次入院后第11天，他突然出现一种无已知感染原因的“脓毒症样”疾病，有大量瘀点和瘀斑，明显肺水肿且弥漫性肺浸润加重，严重低氧血症，意识减退，轻度血小板减少。3天后他死亡。除痰培养巨细胞病毒阳性外，所有培养均为阴性。尸检显示严重骨质疏松、多处椎体压缩性骨折和广泛的大量脂肪栓子。这是首次报道脂肪栓子作为肺移植受者死亡原因的病例，该病例提示，对于长期接受类固醇治疗的患者，尤其是在椎体压缩性骨折的情况下，在脓毒症样疾病的鉴别诊断中应考虑脂肪栓塞综合征。
