Spinal Epidural Lipomatosis in a Human Immunodeficiency Virus-Positive Patient Receiving Steroids and Protease Inhibitor Therapy

Abstract

We describe a patient who became cushingoid as a result of receiving steroid therapy for thrombocytopenia purpura and who then developed spinal epidural lipomatosis 4 months after he started receiving ritonavir as part of his therapy for human immunodeficiency virus infection. We believe that ritonavir may have contributed to the development of epidural lipomatosis and that clinicians should be aware of this possible association.

Spinal epidural lipomatosis in children with renal diseases receiving steroid therapy

“…There was no significant difference in the cumulative dosage of prednisone per kilogram between patients with SSEL and patients without SSEL in our study. Meanwhile in only 8 of 56 patients (14.3%), with the exception of our 5 patients, [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25] has the cumulative dosage of prednisone per kilogram been described (250, 293, 328, 347, 409, 418, 780, 1,480 mg/ kg, respectively). In 9 of 13 patients (69.2%), including our patients, SSEL occurred within a prednisone dosage of about 400 mg/kg.…”

“…In 9 of 13 patients (69.2%), including our patients, SSEL occurred within a prednisone dosage of about 400 mg/kg. The cumulative dosage of prednisone described in 55 patients [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25] was between 2.2 and 357.7 g (57.4€76.7 g). Of the 55 patients, 9 (16.4%) had more than 100 g and 10 of 55 patients (18.2%) had less than 10 g. The cumulative dosage varies very widely and therefore may not be an important risk factor for SSEL.…”

“…This report is the first on the frequency of SSEL in children. The small number of published reports may be the result of this condition being overlooked or misinterpreted as vertebral compression fractures on plain film X-ray evaluation or steroid-induced myopathy, because SSEL is often associated with vertebral compression fractures [18 of 29 patients (62%)] [1,4,5,6,7,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25] (Table 2). Since MRI became available, we have performed spinal MRI for patients who complained of back pain or numbness as possible symptoms of early-stage SEL, and detected 5 patients with SSEL.…”

“…Hierholzer et al [8] described 33 patients with SSEL in a literature review in 1996. We have identified another 29 patients, including 3 French and 2 Japanese reports [1,4,5,6,7,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25], and we therefore review a total of 62 patients, including 12 children. The underlying diseases were 10 bronchial asthma, 8 nephrotic syndrome, 7 renal transplantation, 5 heart transplantation, 4 ulcerative colitis, and others.…”

Severity of presentation is associated with time to recovery in spinal epidural lipomatosis

“…In the 17 surgical patients with available data, the time course of patients' neurological deterioration was noted in days [6][7][8]10,11,13,14,17,18,20,23,24,[26][27][28][29][30][32][33][34]36,37]. The duration of symptoms refers to the period of time between when the patient first reported noticing symptoms and their definitive surgery.…”