Bone marrow necrosis and fat embolism syndrome in sickle cell disease during COVID‐19 infection treated successfully with sequential red cell and plasma exchange

Abstract

Fat embolism syndrome (FES) is a rare life‐threatening condition that is particularly seen in milder forms of sickle cell disease (SCD). Widespread systemic fat emboli are generated in the context of extensive bone marrow necrosis. Multi‐organ failure with a high morbidity and mortality may quickly develop. Infection with Parvovirus B19 is a common precipitant. Here, the authors report the case of a 35‐year‐old Afro‐Caribbean man with HbSC disease who presented with FES having tested positive for SARS‐COV‐2. He rapidly became critically ill and required admission to the intensive care unit for organ support. He was treated with red cell exchange and plasma exchange and made a good recovery to leave hospital at week 7.

Fat Embolism Syndrome Mimicking Thrombotic Thrombocytopenic Purpura in a Patient With Hemoglobin S/Beta-Thalassemia

“…Distinguishing between the two diagnoses can be more complex in the setting of hemoglobinopathy due to chronic hemolysis. FES can rarely cause a triad of neurological impairment, thrombocytopenia, and organ failure making presentation nearly identical to TTP [ 13 , 14 ]. Respiratory distress appears to be a distinguishing feature between the two as it is more common in FES; however, as demonstrated with our patient, relying on clinical presentation can be deceiving in these cases.…”