ABSTRACT
Introduction and importance: Fat embolism syndrome (FES) arises from the systemic effects of fat emboli in microcirculation. While sepsis is characterized by pathological, physiological, and metabolic abnormalities caused by infection. Septic shock is identified by elevated blood lactate (>2 mmol/l) and the need for vasopressors to maintain a mean arterial pressure of 65 mmHg or higher in the absence of hypovolemia. Case presentation: This case report discusses the clinical course and treatment of a 50-year-old male involved in a road traffic accident resulting in polytrauma. The patient presented with multiple fractures, hemopneumothorax, lung contusions, and rib fractures. He was then stabilized following which fractures were reduced and managed operatively. Postoperatively, the patient developed FES with septic shock, manifested by altered consciousness, petechial rashes, and respiratory distress. He was managed with intubation, chest drainage, and a combination of antibiotics, anticoagulants, and vasoactive agents. A tracheostomy was performed due to respiratory insufficiency. Following 29 days in the SICU, the patient's condition was stabilized and shifted to the general ward for further management. He was discharged after 48 days, with a complete recovery and a 2-week follow-up. This case report depicts the challenges in the management of FES with septic shock following polytrauma. Conclusion: This case report is a comprehensive overview of FES complicated with septic shock. It highlights the importance of supportive care as the primary treatment modality, incorporating various medical interventions. The successful outcome and complete recovery of the patient underline the significance of prolonged monitoring, wound care, and physiotherapy.
ABSTRACT
Introduction and importance: Dengue fever is a mosquito-borne viral infection presenting with high-grade fever and other constitutional symptoms. Case presentation: This case report details a rare occurrence of lateral rectus palsy in an 18-year-old male subsequent to dengue infection. The patient initially presented with fever, a generalized tonic-clonic seizure (GTCS), and symptomatic hypoglycemia, leading to multiple organ dysfunction syndrome (MODS) necessitating intensive care. Remarkably, no haemorrhagic manifestations were observed. The MODS gradually resolved by the 12th day of admission, coinciding with the emergence of complaints about uniocular diplopia and right esotropia. Systemic examination, including a normal computed tomography (CT) head scan, did not reveal any abnormalities. Additionally, potential causes contributing to esotropia and diplopia were ruled out. The patient was subsequently managed expectantly for lateral rectus palsy following severe dengue. Follow-up assessments indicated a gradual improvement in esotropia and diplopia, and the patient was advised to continue the prescribed medications. Conclusion: This is the first documented case report of paralytic squint post-severe dengue in Nepal, emphasizing the importance of considering it as a differential diagnosis in tropical regions with endemic dengue infections. The case report advocates early identification and treatment of ophthalmic issues, notably with prednisolone, to achieve favourable outcomes, as evidenced by improvements in visual acuity, esotropia, and diplopia during follow-ups. Further research is essential to determine optimal treatment strategies for such neurological complications associated with dengue fever.