Spinal cord compression by epidural lipomatosis in juvenile rheumatoid arthritis

Abstract

Two cases of spinal cord compression secondary to steroid‐induced epidural lipomatosis in systemic juvenile rheumatoid arthritis (JRA) patients are reported. This complication of prolonged corticosteroid therapy has not been described previously in children with JRA. Epidural lipomatosis should be considered in the differential diagnosis of JRA patients receiving high‐dose and/or prolonged corticosteroid therapy who present with neurologic signs and symptoms referable to the spinal cord.

Symptomatic epidural lipomatosis of the spinal cord in a child: MR demonstration of spinal cord injury

“…Cases not associated with glucocorticoid excess are referred to as idiopathic [6]. Only a single case has been reported in childhood [1].…”

“…Epidural lipomatosis is largely described in association with high-dose, prolonged corticosteroid therapy, although it may be induced by long-term low-dose use of steroids [6,7,8]. Cases not associated with glucocorticoid excess are referred to as idiopathic [6].…”

“…Furthermore, it demonstrates the utility of MR to rule out other causes of spinal cord damage in patients with chronic steroid treatment, including vertebral body compression fracture, abscess formation and malignancies related to inmunosuppression, hematoma, transverse myelitis, congenital spinal stenosis, and herniated disc [1,3,6].…”

“…It has been reported almost exclusively in the setting of iatrogenic Cushing's syndrome [2,3] and in moderately to severely obese patients who have no other premorbid medical condition [4,5]. Epidural lipomatosis is rarely described in children, with five reported cases [2,3,6], one of which was associated with chronic steroid use [1].…”

Neurogenic claudication by epidural lipomatosis: a case report and review of literature

“…SLE [4,5], dermatomyositis [6], rheumatoid arthritis [7], chronic obstructive pulmonary disease [3,8]). Epidural lipomatosis is uncommon in patients with an endogenous elevation of steroids, as in Cushing's syndrome [9].…”