Rare Case of Spinal Neurosarcoidosis with Concomitant Epidural Lipomatosis

Abstract

Introduction. Spinal neurosarcoidosis is a rare disease that can manifest as myelopathy, radiculopathy, or cauda equine syndrome. Spinal epidural lipomatosis is also a rare condition resulting from overgrowth of epidural fat tissue causing compressive myelopathy. To our knowledge, there are no reports linking epidural lipomatosis and spinal neurosarcoidosis. Case Report. We describe a case of progressive myelitis in the presence of concomitant spinal neurosarcoidosis and epidural lipomatosis which was a challenging diagnosis with complete response to treatment after addressing both diseases. Both etiologies are inflammatory in nature and share similar expression of inflammatory factors such as TNF-α and IL-1β. Conclusion. The common inflammatory process involved in these two diseases might explain a pathophysiological interconnection between both diseases that may underlie their concomitant development in our patient. If these two diseases are interconnected, in their pathophysiological mechanism remains a hypothesis that will need further investigation.

Spinal Epidural Lipomatosis: A Comprehensive Review

“…26 One study reported aberrant lipid metabolism to be related to idiopathic SEL. 54 However, these patients were also obese, again highlighting the controversial definition of idiopathic disease. 26 While not an established risk factor, concomitant spinal neurosarcoidosis with SEL has been reported.…”

“…1,59,60 CONSERVATIVE AND MEDICAL MANAGEMENT Weight reduction should be pursued for obese patients, regardless of underlying etiology, as studies have shown improvement of symptoms irrespective of the cause. 1,54,61 The degree of weight reduction for symptomatic improvement varies from patient to patient, although one study recommended a 15-kilogram reduction to improve SEL-related symptoms. 18 More aggressive weight reduction methods, such as bariatric surgery and calorie-restricted diets, have also been noted to provide clinical improvement due to significant loss of epidural fat deposition.…”

Outcome of posterior decompression for spinal epidural lipomatosis

“…Other risk factors include exogenous steroid intake and previous spinal surgery [ 30 ]. An association with neurosarcoidosis and inflammatory involvement of the factors TNFα and IL-1β has also been described [ 15 ]. Furthermore, studies have been able to show that depending on the etiology of SEL, different localizations in the spine are affected [ 10 , 17 , 18 , 24 ].…”