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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Fat Embolism | 11A0 Case 11 History
Case 11 History ---- The decedent was a 57-year-old female with a history of sickle cell disease complicated by chronic pain (previously treated with intra-articular steroid injections), avascular necrosis of the left femur, iron overload and a further history of obstructive sleep apnea, gastroesophageal reflux disease, and bipolar disorder. The patient had a C6-C7 dexamethasone injection in November 2023 for treatment of chronic pain. She was admitted to an outside hospital on November 16th with neck pain. Imaging studies were reassuring for absence of any spinal injury. While hospitalized, she was found to be hypoxic on several mornings and received supplemental oxygen. On the morning of November 20th, she was found unresponsive and required emergent intubation for hypoxic respiratory failure. She was transferred to BJC on 11/20 with concern for acute chest syndrome in the setting of hypoxic respiratory failure. Further workup revealed multiple brain infarcts, superior vena cava syndrome, and imaging findings of osseous sequelae of sickle cell disease including osteonecrosis. The diffuse, small brain infarcts were thought consistent with fat micro-emboli. Despite weaning sedation, the patient’s neurologic exam demonstrated inability to open eyes to voice or noxious stimuli, and minimally reactive pupils. The patient’s neurologic exam did not significantly improve over her hospital course. Given the poor neurologic prognosis, after discussion with the family, the patient was transitioned to a comfort-focused treatment plan, including removal of mechanical ventilation and she expired on December 4th.
