Journal Information
Vol. 98. Issue 5.
Pages 397-398 (1 May 2023)
Vol. 98. Issue 5.
Pages 397-398 (1 May 2023)
Images in Paediatrics
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Lipomatosis epidural secundaria a corticoterapia
Epidural lipomatosis secondary to corticotherapy
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Marina Mora Sitjaa,
Corresponding author
marina.mora@salud.madrid.org

Corresponding author.
, Jorge Huerta Aragonésb, María Sanz Fernándeza, Carmen Garrido Colinob
a Sección Endocrinología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
b Sección Hematología y Oncología Hospital General Universitario Gregorio Marañón, Madrid, Spain
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A male patient aged 15 years who had received a diagnosis of Evans syndrome required prolonged treatment with prednisone (2mg/kg/day for 4 weeks, followed by a dose of 1mg/kg day that could not be reduced due to recurrence). At 3 months of treatment, he started experiencing intense, activity-limiting lumbar pain unresponsive to analgesia, progressive, radiating from the lower extremities and decreased proximal strength (4/5). The patient was admitted for evaluation and pain management. A magnetic resonance imaging (MRI) scan of the spine evinced extensive spinal epidural lipomatosis (Fig. 1) secondary to the treatment.

Figure 1.

Magnetic resonance of the spine evincing an increase in epidural fat (spinal epidural lipomatosis) resulting in stenosis of the spinal canal at the dorsal (1A) and lumbar (1B) levels. The mass effect was most severe in the L4-S1 segment (1B) and possibly compounded by congenital lumbar canal stenosis.

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Conservative treatment with analgesia and rehabilitation was initiated at the same time as mycophenolate mofetil for treatment of Evans syndrome with the aim of tapering off the steroid, which was withdrawn completely 3 months after the diagnosis of lipomatosis without any complications. The patient had a favourable outcome.

Spinal epidural lipomatosis is characterised by an overgrowth of fatty tissue in the epidural sac in the spinal canal that can cause progressive compression of the spinal cord. Steroid therapy has been described as its most common cause1,2, and while spinal epidural lipomatosis is a rare adverse event, it should be suspected in patients presenting with compatible symptoms compatibles (lumbar pain, pain and loss of strength in lower extremities). Magnetic resonance is the gold standard of diagnosis3 and the first-line treatment is conservative—with some patients requiring surgical decompression2—with withdrawal of the steroid whenever possible.

Funding

This research did not receive any external funding.

Conflicts of interest

The authors have no conflicts of interest to declare.

References
[1]
J.C. Möller, R.Q. Cron, D.W. Young, H.J. Girschick, D.M. Levy, D.D. Sherry, et al.
Corticosteroid-induced spinal epidural lipomatosis in the pediatric age group: report of a new case and updated analysis of the literature.
Pediatr Rheumatol Online J, 9 (2011), pp. 5
[2]
P.B. Walker, C. Sark, G. Brennan, T. Smith, W.F. Sherman, A.D. Kaye.
Spinal Epidural Lipomatosis: A Comprehensive Review.
Orthop Rev (Pavia), 13 (2021), pp. 25571
[3]
A. Muñoz, J.A. Barkovich, F. Mateos, R. Simón.
Symptomatic epidural lipomatosis of the spinal cord in a child: MR demonstration of spinal cord injury.
Pediatr Radiol, 32 (2002), pp. 865-868
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