Prednisolone
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Epidural spinal lipoma leading to paraparesis: case report A 22-year-old man developed an epidural spinal lipoma leading to paraparesis after receiving prednisolone for rheumatoid polyarthritis. The man experienced a progressive, subacute paraparesis which ultimately led to an inability to walk. On admission, incontinence and spastic paraplegia were evident, and sensory loss was found to localised to below the level of T4. A review of his medical history showed that he took high doses of prednisolone for 8 years [route and time to reaction onset not stated] to treat rheumatoid polyarthritis. A centripetal fat deposition on his face, neck and trunk was present, as were dermatological side effects of cortisone use. CT and MRI scans of the thoracic spine revealed a dorsal epidural mass compressing the spinal cord. A decrease in the height of several vertebral bodies due to osteoporosis was also seen. The man underwent decompression of the spinal cord by interlaminar fenestration at four levels to remove the hypertrophic epidural fat. He was able to move his lower limbs a few hours after surgery. Decompression of the spinal cord was evident on MRI. His paraplegia further recovered during a prolonged course. However, 6 months later he died from heart failure. Author comment: "The development of steroid-induced spinal lipoma is independent of steroid dosage, and it may occur even in patients receiving [a] low dosage of prednisolone". Mirzayan MJ, et al. Subacute steroid-induced paraparesis: surgical treatment of a devastating "invisible" side effect. European Spine Journal 21: S542-4, Jun 2012. Available from: URL: http://dx.doi.org/10.1007/s00586-012-2185-3 803081186 Germany
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Editorial comment: This report included another patient who developed steroid-induced paraparesis. However, the steroid used was not specified.
0114-9954/10/1432-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 15 Dec 2012 No. 1432
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