Lipomatosis of spinal epidural space, peritoneum, and renal sinus: a rare complication of long-term steroid therapy in a child with nephrotic syndrome

Sharawat, Indar Kumar; Bhattacharya, Dipasri; Indla, Ravi Teja; Bhatia, Anmol; Tiewsoh, Karalanglin

doi:10.1007/s00381-019-04141-z

Cited by 8 publications

(5 citation statements)

References 21 publications

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“…Several case articles have been published over the years about lipomatosis, however, it is clearly understood that different types of metabolic diseases cause high accumulation of EF, leading to neurological symptoms. 5,[37][38][39][40] SEL was first reported by Lee et al 41 in 1975 in a patient who underwent renal transplantation and was receiving corticosteroids. Therefore, studies have shown that SEL is primarily associated with corticosteroid use 42,43 and endocrine disorders, with increased production of endogenous corticosteroids.…”

Section: Ef and Pathologic Conditionmentioning

confidence: 96%

“…The etiology of this abnormality varies according to different patients reports. Several case articles have been published over the years about lipomatosis, however, it is clearly understood that different types of metabolic diseases cause high accumulation of EF, leading to neurological symptoms 5,37–40 SEL was first reported by Lee et al41 in 1975 in a patient who underwent renal transplantation and was receiving corticosteroids.…”

Section: Anatomy Of Ef Tissuementioning

confidence: 99%

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The Mysterious Role of Epidural Fat Tissue in Spine Surgery

Alonge

Guo

Wang

et al. 2021

Clinical Spine Surgery: A Spine Publication

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Background: Though both neurosurgeons and orthopedic spinal surgeons are keenly aware of the clinical importance of epidural fat (EF), surgical practice varies amongst individual surgeons and across both fields. Thus, an in-depth understanding of the anatomical structure and composition of EF is vital, as it will play a significant role in the therapeutic management and the surgical choice of treatment.Objective: We aim to extensively review the anatomical and biological properties of EF and further outline the surgical importance of EF management.

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Section: Ef and Pathologic Conditionmentioning

confidence: 96%

Section: Anatomy Of Ef Tissuementioning

confidence: 99%

The Mysterious Role of Epidural Fat Tissue in Spine Surgery

Alonge

Guo

Wang

et al. 2021

Clinical Spine Surgery: A Spine Publication

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“…Obesity is a major contributing factor to the development of SEL [ 3 ]. Other predisposing conditions include thyroid disease, Cushing’s disease, steroid use, and others [ 4 , 5 ]. In terms of presentation, SEL typically presents concomitantly with other degenerative spine pathology.…”

Section: Introductionmentioning

confidence: 99%

Acute Spinal Cord Injury Due to Epidural Lipomatosis Without Osseous Injury

Mugge¹,

Dang²,

Dang³

et al. 2022

Cureus

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Spinal epidural lipomatosis (SEL) is a common pathology of the lumbar spine. While the natural history is not well understood, there is a strong association with metabolic syndrome and endocrine dysfunction. Clinical presentation typically involves slow, progressive onset of radicular and myelopathic symptoms. Treatment primarily consists of weight loss, while surgery is reserved for refractory cases or acute cauda equina syndrome. We present a case of acute spinal cord injury (SCI) after trauma with underlying SEL in the cervicothoracic spine. Additionally, a literature review using a MEDLINE search of the English literature through April 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed to identify all documented cases of acute spinal cord injury with underlying SEL. A 72-year-old obese male with insulin-dependent diabetes mellitus presented with subacute bilateral lower extremity weakness after a fall with a flank injury three days prior to evaluation. Within hours of admission, the patient acutely progressed to paraplegia and sensory loss below the T6 level consistent with an ASIA (American Spinal Injury Association) A spinal cord injury. No fracture or dislocation was identified on CT imaging. MRI of the thoracic spine revealed spinal cord compression secondary to extensive posterior epidural lipomatosis with resultant anterior displacement of the thecal sac. The patient underwent emergent T2-T9 laminectomy for decompression. Post-operatively, the patient regained sensation below the level of injury. A review of the literature reviewed no published articles on cases of complete spinal cord injury secondary to underlying SEL without associated fracture. Finally, we present the first report of an acute spinal cord injury in the setting of SEL without fracture. Our case demonstrates that SEL outside the lumbar spine confers increased risk for SCI following trauma. Patients with cervicothoracic SEL may require close neurological observation and timely surgical decompression.

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“…1 The judicious use of these medications is important owing to their adverse effects. 2 Steroid-induced psychosis is seen in 2–6% of the adult population 3 but is not uncommon in children. Patients may become symptomatic within a week of starting high dose steroid therapy.…”

Section: Introductionmentioning

confidence: 99%

Trichotillomania in a child with nephrotic syndrome: An unusual steroid induced psychiatric manifestation

et al. 2021

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Steroid-induced psychosis is a known serious adverse effect seen commonly in adults but less commonly in children. We present a seven-year-old girl with steroid-dependent nephrotic syndrome who developed abnormal behaviour, trichotillomania, alopecia and mood changes. She was investigated to rule out other causes and treated with tapering steroids, fluoxetine and olanzapine. A marked improvement was noted after two months. Patients on long term or high dose steroids should be monitored for adverse psychological effects of steroids, as early recognition and intervention can improve the outcome.

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Lipomatosis of spinal epidural space, peritoneum, and renal sinus: a rare complication of long-term steroid therapy in a child with nephrotic syndrome

Cited by 8 publications

References 21 publications

The Mysterious Role of Epidural Fat Tissue in Spine Surgery

The Mysterious Role of Epidural Fat Tissue in Spine Surgery

Acute Spinal Cord Injury Due to Epidural Lipomatosis Without Osseous Injury

Trichotillomania in a child with nephrotic syndrome: An unusual steroid induced psychiatric manifestation

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