srjmsSRJMSSRJMS2788-948310.47310/srjcms.2025.v05i01.019Fat Embolism-A Diagnostic and Therapeutic Dilemma: A Case ReportBackground: Fat embolism syndrome (FES) is a rare but potentially life-threatening condition characterized by respiratory distress, neurological symptoms and petechial rash. It most commonly occurs after long bone fractures but can also be associated with non-traumatic conditions. Early diagnosis remains a challenge due to its nonspecific presentation and overlap with other causes of acute respiratory distress syndrome (ARDS) [1,2]. Case Presentation: We report the case of a 31-year-old male who sustained a tibia and fibula fracture after a motorcycle accident. He remained asymptomatic initially but developed progressive respiratory distress and confusion on the fourth day post-injury. Despite normal initial imaging and investigations, subsequent HRCT revealed bilateral ground-glass opacities with pleural effusion, consistent with ARDS. Diagnostic considerations included FES and COVID-19 pneumonia, but a negative RT-PCR result and the presence of retinal fat emboli confirmed FES. The patient was managed with supportive oxygen therapy and underwent surgical fixation, leading to gradual recovery [3,4]. Discussion: FES pathophysiology is explained by mechanical and biochemical theories. Diagnosis is primarily clinical, supported by imaging and specific criteria such as Gurd’s and Schonfeld’s criteria. Management is mainly supportive, with early fracture fixation playing a key preventive role. This case highlights the diagnostic challenge of FES, particularly in the context of a delayed presentation and an absence of petechial rash [5-7]. Conclusion: A high index of suspicion for FES is essential in post-trauma patients developing unexplained respiratory distress. Early recognition and prompt supportive care can lead to favorable outcomes.