Paradoxical Cerebral Fat Embolism in an Adolescent PLHA: A Convergence of Trauma, ART Induced Hypercoagulability, and Septal Heart Defect
Fat embolism syndrome (FES) is a life-threatening complication following long bone fractures, primarily affecting the pulmonary circulation. However, cerebral fat embolism (CFE) is a rare yet severe variant that can occur when fat emboli bypass the lungs through a right-to-left cardiac shunt, such...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Tehran University of Medical Sciences
2025-07-01
|
| Series: | Case Reports in Clinical Practice |
| Subjects: | |
| Online Access: | https://crcp.tums.ac.ir/index.php/crcp/article/view/1036 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849393937801805824 |
|---|---|
| author | Abhijeet Sharma Akansha Jain |
| author_facet | Abhijeet Sharma Akansha Jain |
| author_sort | Abhijeet Sharma |
| collection | DOAJ |
| description |
Fat embolism syndrome (FES) is a life-threatening complication following long bone fractures, primarily affecting the pulmonary circulation. However, cerebral fat embolism (CFE) is a rare yet severe variant that can occur when fat emboli bypass the lungs through a right-to-left cardiac shunt, such as an atrial septal defect (ASD). In individuals with HIV on antiretroviral therapy (ART), persistent endothelial dysfunction and
ART-induced hypercoagulability predispose them to an exaggerated thrombo-inflammatory state, amplifying the risk of paradoxical embolism. We describe a 14-year-old male with perinatally acquired HIV on ART who presented after a high-impact road traffic accident. The patient sustained comminuted fractures of the right
femoral shaft, tibia, and femoral condyle. Initially neurologically intact (Glasgow Coma Scale [GCS] 15), he experienced rapid neurological deterioration (GCS dropped to 8), alongside respiratory distress and acute respiratory distress syndrome (ARDS)-like symptoms. Urgent evaluation with a 2D echocardiogram revealed an ASD with a right-to-left shunt, strongly supporting the diagnosis of paradoxical cerebral fat embolism.
This case illustrates how trauma, combined with HIV-related endothelial dysfunction, ARTinduced hypercoagulability, and a congenital cardiac anomaly, can converge to precipitate severe neurological decline through paradoxical embolism.
|
| format | Article |
| id | doaj-art-4adc3adde08f49428a6a5c091736ef0f |
| institution | Kabale University |
| issn | 2538-2683 2538-2691 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Tehran University of Medical Sciences |
| record_format | Article |
| series | Case Reports in Clinical Practice |
| spelling | doaj-art-4adc3adde08f49428a6a5c091736ef0f2025-08-20T03:40:14ZengTehran University of Medical SciencesCase Reports in Clinical Practice2538-26832538-26912025-07-019610.18502/crcp.v9i6.18950Paradoxical Cerebral Fat Embolism in an Adolescent PLHA: A Convergence of Trauma, ART Induced Hypercoagulability, and Septal Heart DefectAbhijeet Sharma0Akansha Jain1Swami Vivekanand Subharti University, Meerut, India.Moti Lal Nehru Medical college, Prayagraj, India. Fat embolism syndrome (FES) is a life-threatening complication following long bone fractures, primarily affecting the pulmonary circulation. However, cerebral fat embolism (CFE) is a rare yet severe variant that can occur when fat emboli bypass the lungs through a right-to-left cardiac shunt, such as an atrial septal defect (ASD). In individuals with HIV on antiretroviral therapy (ART), persistent endothelial dysfunction and ART-induced hypercoagulability predispose them to an exaggerated thrombo-inflammatory state, amplifying the risk of paradoxical embolism. We describe a 14-year-old male with perinatally acquired HIV on ART who presented after a high-impact road traffic accident. The patient sustained comminuted fractures of the right femoral shaft, tibia, and femoral condyle. Initially neurologically intact (Glasgow Coma Scale [GCS] 15), he experienced rapid neurological deterioration (GCS dropped to 8), alongside respiratory distress and acute respiratory distress syndrome (ARDS)-like symptoms. Urgent evaluation with a 2D echocardiogram revealed an ASD with a right-to-left shunt, strongly supporting the diagnosis of paradoxical cerebral fat embolism. This case illustrates how trauma, combined with HIV-related endothelial dysfunction, ARTinduced hypercoagulability, and a congenital cardiac anomaly, can converge to precipitate severe neurological decline through paradoxical embolism. https://crcp.tums.ac.ir/index.php/crcp/article/view/1036Fat embolism syndromeCerebral fat embolismPeople living with HIV/AIDS(PLHA)Antiretroviral therapy |
| spellingShingle | Abhijeet Sharma Akansha Jain Paradoxical Cerebral Fat Embolism in an Adolescent PLHA: A Convergence of Trauma, ART Induced Hypercoagulability, and Septal Heart Defect Case Reports in Clinical Practice Fat embolism syndrome Cerebral fat embolism People living with HIV/AIDS(PLHA) Antiretroviral therapy |
| title | Paradoxical Cerebral Fat Embolism in an Adolescent PLHA: A Convergence of Trauma, ART Induced Hypercoagulability, and Septal Heart Defect |
| title_full | Paradoxical Cerebral Fat Embolism in an Adolescent PLHA: A Convergence of Trauma, ART Induced Hypercoagulability, and Septal Heart Defect |
| title_fullStr | Paradoxical Cerebral Fat Embolism in an Adolescent PLHA: A Convergence of Trauma, ART Induced Hypercoagulability, and Septal Heart Defect |
| title_full_unstemmed | Paradoxical Cerebral Fat Embolism in an Adolescent PLHA: A Convergence of Trauma, ART Induced Hypercoagulability, and Septal Heart Defect |
| title_short | Paradoxical Cerebral Fat Embolism in an Adolescent PLHA: A Convergence of Trauma, ART Induced Hypercoagulability, and Septal Heart Defect |
| title_sort | paradoxical cerebral fat embolism in an adolescent plha a convergence of trauma art induced hypercoagulability and septal heart defect |
| topic | Fat embolism syndrome Cerebral fat embolism People living with HIV/AIDS(PLHA) Antiretroviral therapy |
| url | https://crcp.tums.ac.ir/index.php/crcp/article/view/1036 |
| work_keys_str_mv | AT abhijeetsharma paradoxicalcerebralfatembolisminanadolescentplhaaconvergenceoftraumaartinducedhypercoagulabilityandseptalheartdefect AT akanshajain paradoxicalcerebralfatembolisminanadolescentplhaaconvergenceoftraumaartinducedhypercoagulabilityandseptalheartdefect |