DR. JOHN MCCARTHY. A 29-year-old man, previously in good health, was admitted to Queen of the Valley Hospital in West Covina, California, after sustaining severe multiple traumatic injuries in a fall from his motorcycle. The significant findings on admission were related to his left lower extremity; there was a gaping laceration of the distal anterior thigh, with complete transverse severance of the quadriceps muscle group and a fractured femur protruding through the wound. Also evident were compound fractures of the tibia and fibula, with gaping lacerations anteriorly and posteriorly. The left foot was cool and pale. An arteriogram revealed partial disruption of the arterial blood supply to the extremity. The patient was given tetanus-diphtheria toxoid, tetanus immune globulin, and 1 g of cefazolin intravenously for wound prophylaxis. Open reduction and internal fixation of the comminuted distal tibia-fibula fractures were performed. Traction pins were placed in the distal femur; the quadriceps muscle was approximated, and the multiple lacerations were irrigated and repaired. Treatment with cefazolin (1 g every 8 hours) was continued postoperatively. The left foot became warmer, and a pulse detectable by Doppler examination was found after surgery. Subsequently, the patient underwent an anterior compartment fasciotomy, and pulses in the left foot continued to improve. On the fifth day of hospitalization, the patient developed a fever up to 102?F that was accompanied by shortness of breath; he denied a history of chest pain, cough, sputum production, or hemoptysis. He complained of difficulty in speaking clearly, weakness of all of his limbs, and increased pain in his left lower extremity. Infectious disease and pulmonary consultations were requested at this time. On examination the patient was found to be a well-devel-