From dyspnea to skin grafting: the difficulties of managing a patient with extreme obesity

Introduction: While the prevalence of severe obesity is increasing worldwide, caregivers are often challenged with the management of patients with extreme weight. 
Case report: A 30-year-old woman (weight 245 kg, body mass index 85 kg/m²) presented with dyspnea for which investigations led to suspect pulmonary embolism. The patient’s weight made it impossible to perform adapted imaging, thus, an empirical anticoagulant treatment was initiated. A hematoma of the thigh occurred as a consequence of a transient antivitamin K overdose leading to a 15 cm necrotic wound worsened by a state of malnutrition. Multidisciplinary and comprehensive care was performed including wound trimming, antibiotics, skin grafting, treatment of malnutrition, and psychological support, but with marked difficulties, due to the lack of adapted medical equipment and facilities as well as appropriate medical guidelines. Overall, 7 months of hospitalization including 4 months of physiotherapy and rehabilitation were needed before the patient could return home. 
Discussion: This case highlights how difficult managing patients with extreme obesity can be and points to the importance for healthcare systems to adapt to the specific needs of these patients and to design specific guidelines for treatment dosage and malnutrition prevention and treatment in this setting.
