Sudden death caused by pulmonary fat embolism in a patient with miliary tuberculosis

Abstract

An 84-year-old Japanese woman with myelodysplastic syndrome was admitted with pyrexia and dyspnea, but died suddenly during diagnostic evaluation. The autopsy revealed miliary tuberculosis in addition to myelodysplastic syndrome in the bone marrow. The immediate cause of the patient’s sudden death was pulmonary fat embolism derived from bone marrow necrosis. This case shows that the infiltration of the myelodysplastic bone marrow by tuberculosis and consequent bone marrow necrosis and fat embolism can be the cause of sudden death. In this article, we report the autopsy results of this unusual cause of sudden death, and discuss tuberculosis-related sudden death with a review of the literature.

Cardiac Arrest in an Extensive Pulmonary Tuberculosis Patient

“…TB complications are best understood in two categories, pulmonary and extrapulmonary. In most TB cases, patients die from pulmonary complications such as pneumonia, hemorrhage, airway compression, pulmonary edema, and pleural adhesions leading to respiratory failure and eventually death [2]. Extrapulmonary TB can also lead to death, particularly, if cardiac system is involved.…”

Sudden death caused by Clostridium perfringens sepsis presenting as massive intravascular hemolysis

“…This may explain why fat embolism has not been noticed in patients with C. perfringens infection. In the present case, although the exact mechanisms for the development of PFE could not be determined, bone marrow necrosis, which is known to be an etiology of PFE, 28 may have been responsible for PFE. Severe hypoxia as well as toxic attack due to C. perfringens sepsis must have caused bone marrow necrosis.…”

“…6,27 On the other hand, it may be possible to consider PFE as a complication of sternal compression in CPR because PFE is frequently observed in the elderly subjected to such a procedure. 30 Apart from CPR-related PFE, since PFE alone can be the cause of sudden death, 28 it should be recognized as a possible fatal complication of C. perfringens infection.…”