Epidural Spinal Lipomatosis With Acute Onset of Paraplegia in an HIV-Positive Patient Treated With Corticosteroids and Protease Inhibitor

Vince, Giles Hamilton; Brucker, Claudia; Langmann, Peter; Herbold, Christian; Solymosi, L.; Roosen, K.

doi:10.1097/01.brs.0000176314.89648.78

Cited by 18 publications

(16 citation statements)

References 22 publications

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“…In descending order or frequency [1], this condition is associated with chronic corticosteroid use [9][10][11][12][13][14][15][16], obesity [9,17,18], excessive endogenous production of cortisol [2,3,[19][20][21][22], and highly active antiretroviral therapy (HAART) [4,[23][24][25]. It occurs more commonly in men (75%) than women (25%).…”

Section: Discussionmentioning

confidence: 99%

Transforaminal epidural steroid injection in the treatment of lumbosacral radicular pain caused by epidural lipomatosis: A case series and review

McCormick

Plastaras

2014

BMR

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Section: Discussionmentioning

confidence: 99%

Transforaminal epidural steroid injection in the treatment of lumbosacral radicular pain caused by epidural lipomatosis: A case series and review

McCormick

Plastaras

2014

BMR

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“…Only a few HIV-infection-associated SEL have been reported so far [5][6][7]9,10] and attributed to cART-induced lipodystrophy in the absence of glucocorticoids [6,7,9,10]. One case of HIV-associated SEL was clearly linked to obesity [6] but BMIs were not reported for the others.…”

Section: Introductionmentioning

confidence: 99%

“…She had had 393CD4 cells/μL, with plasma HIV-RNA at < 50 copies/mL, for years. Discussion SEL, a rare condition defined by the pathological overgrowth of normal adipose tissue in the thoracic and lumbosacral epidural spaces, causes nerve-root and spinal cord compression [5,6]. SEL-onset features are insidious and non specific, but delayed diagnosis may lead to severe functional disabilities.…”

Section: Case Reportmentioning

confidence: 99%

Back Pain in HIV-Infected Patients May Be Due to Spinal Epidural Lipomatosis

Moulignier¹,

Lafaurie²,

Marie-Laure³

et al. 2015

J AIDS Clin Res

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“…However, this approach remains controversial as lumbar epidural steroid injections have been implicated in reports of SEL [8]. Surgical intervention, with decompressive laminectomy and adipose tissue resection, is the treatment of choice if conservative treatment is unsuccessful and in cases of spinal cord compression or radiculopathy, and a success rate of 80% has been reported with the best outcomes seen in patients with lumbar involvement and lower preoperative corticosteroids dose [15].…”

mentioning

confidence: 97%

“…Intrathecal structures cannot be assessed without the use of intrathecal contrast medium, although cord oedema cannot be assessed. Myelography is sometimes used to determine the level of maximal CSF effacement in cases of diffuse SEL, where the most appropriate spinal level for surgical decompression may not be readily apparent [15].…”

mentioning

confidence: 99%

Spinal epidural lipomatosis in myeloma

Liew

Bishton

Januszewicz

et al. 2007

Leukemia & Lymphoma

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We describe a case of progressive refractory multiple myeloma presenting with spinal cord compression due to spinal epidural lipomatosis (SEL) and review the literature.A 64-year-old man was diagnosed nine years earlier with multiple myeloma, and baseline skeletal survey showed myelomatous deposits in both humeri, femora, pelvis, and anterior compression fractures of T11, T12, L1, and L3. He was treated with four cycles of infusional vincristine, doxorubicin, and pulse dexamethasone (VAD) chemotherapy followed by high dose melphalan and autologous peripheral blood stem cell transplant in 1998. Following disease progression in 2003, he was started on alpha interferon and 40 mg of dexamethasone weekly. Further progression was treated with daily thalidomide and 40 mg dexamethasone twice weekly. Because of a poor response, bortezomib was initiated in 2006, without concurrent steroids, but the patient failed to respond to this, as well as the combination of cyclophosphamide and dexamethasone 4 mg three times per weekly. From September 2006, the patient was therefore maintained on alternate daily dexamethasone (8 mg) whilst awaiting access to lenalidomide.However, in February 2007, the patient presented with a 7-day history of worsening midthoracic back pain and difficulty in walking, and on admission was in urinary retention, although bowel function was preserved. Clinical examination demonstrated bilateral hip flexion weakness. Reflexes were preserved and there was no clonus. Examination of sensation was complicated due to peripheral neuropathy due to his previous vincristine, thalidomide, and bortezomib treatment, although there was a sensory level at T7/8. The most recent X-ray imaging of his spine in January 2005 had demonstrated compression fractures at T4, T7, and T11 to L2.Magnetic resonance imaging (MRI) demonstrated a marked increase in the quantity of epidural fat, from the level of T2 down to the sacrum, with the largest quantity of epidural fat located at T3 to T9 (Figure 1). The thoracic dural theca was displaced anteriorly with effacement of the subarachnoid space but no spinal cord signal abnormality. In addition, there was extensive myelomatous infiltration of the entire vertebral column with multiple pathological vertebral crush fractures. A bone marrow aspirate and biopsy confirmed a heavy plasma cell infiltrate. His dexamethasone was increased to 40 mg daily, and he underwent urgent thoracic laminectomy of the regions T5 to T8, which confirmed fat infiltration, with only a temporary improvement in strength, and no change to his peripheral paraesthesia. Repeat MRI demonstrated a significant improvement in the degree of thoracic spinal cord displacement, but with worsening thecal compression in the lumbar region. A lumbar laminectomy was therefore performed six days after his thoracic laminectomy. Following this, a trial of dexamethasone cessation was attempted as it was felt that it may have been contributing to his lipomatosis. However, this resulted in immediate deterioration in lower limb strength...

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Epidural Spinal Lipomatosis With Acute Onset of Paraplegia in an HIV-Positive Patient Treated With Corticosteroids and Protease Inhibitor

Abstract: It is important to maintain an awareness for the possible association between HIV lipodystrophy and symptomatic epidural lipomatosis.

Cited by 18 publications

References 22 publications

Transforaminal epidural steroid injection in the treatment of lumbosacral radicular pain caused by epidural lipomatosis: A case series and review

Transforaminal epidural steroid injection in the treatment of lumbosacral radicular pain caused by epidural lipomatosis: A case series and review

Back Pain in HIV-Infected Patients May Be Due to Spinal Epidural Lipomatosis

Spinal epidural lipomatosis in myeloma

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