Steroid-induced spinal epidural lipomatosis in a patient with myasthenia gravis

Excerpt

A 24-year-old man with myasthenia gravis (MG) was referred to our hospital. He had been diagnosed with ocular MG 3 years previously based on characteristic symptoms of fluctuating diplopia and ptosis, a decremental response on repetitive nerve stimulation, and a positive response to pyridostigmine. His disease had not been well controlled after evolving into generalized MG 2 years previously, which led to long-term use of high-dose steroids (25 mg prednisolone daily). Other immunosuppressants, such as tacrolimus or mycophenolate mofetil, were used together, but the steroid dose was not reduced due to poor response. He gained approximately 25 kg due to the steroids. Four months after visiting our hospital, he complained of tingling and numbness in his left leg. Neurological examination revealed normal strength but hypoesthesia in the left L5 and S1 dermatomes. Spine magnetic resonance imaging (MRI) showed extensive fat deposition in the epidural space at the thoracic and lumbar levels, which eventually resulted in severe compression of the thecal sac with a Y-shaped configuration at L2 to L5 levels (Fig. 1). His MRI findings were consistent with spinal epidural lipomatosis (SEL) [1]. His MG was well controlled with intravenous immunoglobulin every 4 weeks, and the steroid dose was reduced (5 mg prednisolone daily). Afterwards, he lost approximately 10 kg and the SEL symptoms in his left leg reduced. Surgical treatment will be considered in the future if SEL symptoms worsen.

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