Symptomatic spinal epidural lipomatosis as a complication of steroid immunosuppression in cardiac transplant patients

Abstract

Patients with Cushing's syndrome may develop spinal epidural lipomatosis, an abnormal accumulation of fat in the spinal epidural space. This accumulation of fat may cause compression of the spinal cord or cauda equina with resulting neurological deficit. Two cases of symptomatic spinal lipomatosis are reported in cardiac transplant patients receiving chronic corticosteroid treatment. The literature is reviewed, and diagnostic and therapeutic considerations are discussed.

Lumbosacral epidural lipomatosis: MRI grading

“…The LEL has previously been reported in renal and cardiac transplant recipients [4,27,47,48] and patients on immunosuppressive therapy for the control of different diseases such as poliarthritis [49], systemic lupus erithematosus [7], rheumatoid arthritis [19,50], asthma [4,33,51], sarcoidosis [51], and Graves' disease [31]. Additional cases of LEL have been seen after extradural corticosteroid injections [24,34].…”

“…In our literature review, 40% of patients (8 of 20 cases) with symptomatic LEL were successfully treated without surgery by use of corticoid-dose reduction [4,29,34,44,47,48,52]. On the other hand, 60% of cases (12 of 20) underwent surgical decompression with fat debulking [1,4,7,24,27,31,33,44,49,50,51,53].…”

Steroid-induced Paraparesis: Spinal Epidural Lipomatosis Complicated by a Wedge Deformity of the Middle Thoracic Vertebrae

“…Long-term steroid therapy causes excessive deposition of body fat in a centripetal fashion about the head, neck and trunk, which is the characteristic bodily habitus of patients with Cushing's syndrome. Excessive deposition of fat is also seen in the spinal epidural space (7). Mostly epidural lipomatosis is associated with high-dose, polonged steroid therapies, although epidural lipomatosis has also been reported to occur with prednisolone doses as low as 15 mg/day for as short a duration as four months (15).…”

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

“…3). Notably, 11/19 patients who presented within 15 months 15 Butcher, 1979 [8] 150 15 Godeau, 1979 [15] 80 6 Lipson, 1980 [20] 92 6 Chapman, 1981 [10] 24.5 11 Chapman, 1981 [10] 50 7 Chapman, 1981 [10] 15 48 Guegan, 1982 [16] 60 15 Archer, 1982 [6] 10 156 George, 1983 [14] 42 6 Randall, 1986 [26] 20 6 Jungreis, 1987 [19] 10 240 Haid, 1987 [17] 20 72 Zampella, 1987 [29] 47.6 21 Zampella, 1987 [29] 60.5 8 Quint, 1988 [25] 20 12 Fessler, 1992 [13] 16 6 Fessler, 1992 [13] 20 12 Fessler, 1992 [13] 10 84 Healy, 1987 [18] 51 44 Soloniuk, 1989 [27] 60 15 Maehara, 1988 [21] 50 44 Tobler, 1988 [28] 24 4 Buthiau, 1988 [9] 40 11 Perling, 1988 [23] 15 48 Pinsker, 1988 of initiation of therapy, as did our patient, were being treated with at least 40 mg of prednisone per day, a relatively high dose. On the other hand, 6/8 patients presenting after more than 4 years of treatment, and both (2/2) patients in the literature who presented after 13 years of treatment were on, at most, 15 mg of prednisone per day.…”