No abstract

Fat embolism syndrome (FES) is a rare condition characterised by the classic triad of respiratory distress, neurologic symptoms and petechial rash. Here, we encountered a case of FES in a patient with an asymptomatic right undisplaced femoral neck fracture (Garden Stage II). FES was diagnosed based on the Gurd and Willson’s diagnostic criteria and brain magnetic resonance imaging features. To the best of our knowledge, this is the first case of FES in a patient with an undisplaced femoral neck fracture. This study highlights the importance of considering the possibility of FES even in patients with undisplaced femoral neck fractures.

Keywords： anti glomerular basement membrane antibody glomerulonephritis, Goodpasture syndrome, simple plasma exchange, Pneumocystis pneumonia, hemodialysis 〈Abstract〉 A 76 year old male with a history of total laryngectomy for laryngeal cancer and pulmonary adenocarcinoma was referred to our hospital with severe renal failure and anuria, which required urgent hemodialysis. Serological tests revealed strong positivity for the anti glomerular basement membrane (GBM) antibody ( ＞350 U/mL), leading to a diagnosis of anti GBM antibody glomerulonephritis. Although steroid pulse therapy and plasma exchange were performed, the patientʼs antibody titer always exceeded the upper limit of the detection range. As his renal function was not expected to improve, he was switched to maintenance dialysis, while the steroid dose was gradually reduced. Inhaled pentamidine was administered to prevent Pneumocystis pneumonia. After discharge, fever, bloody sputum, and elevated serum β D glucan levels were observed, and bronchoscopy revealed Pneumocystis pneumonia and diffuse alveolar hemorrhaging. The oral administration of trimethoprim/ sulfamethoxazole and corticosteroid therapy ameliorated the pneumonia and alveolar hemorrhaging, and additional plasma exchange reduced the patientʼs anti GBM antibody titer. In this case, a patient with high titer anti GBM antibody nephritis was considered to have developed alveolar hemorrhaging triggered by Pneumocystis