Abstract
Spinal epidural lipomatosis (SEL) is an abnormal accumulation of normal adipose tissue in the extradural space within the spinal canal that can lead to notable spinal cord compression. It is most commonly reported in patients receiving chronic glucocor¬ticoids. Other causes can include obesity and hypercortisolism. Unusually, SEL may occur in human immunodeficiency virus (HIV)-infected patients, and has been attributed to the lipodystrophy and altered fat metabolism associated with antiretrovirals. We describe a 56-year-old, HIV-infected, non-obese woman with satisfactory immunovirological indices on combined antiretroviral therapy who developed debilitating back pain initially attributed to osteoarthritis. A thorough neurological work-up with magnetic resonance imaging (MRI) led to the diagnosis of rapidly progressive SEL that was not associated with any of its common etiologies.
Highlights
Low back pain (LBP) is a frequent complaint of up to 80% of middleaged persons at some time during their life [1]
Determining the LBP etiology is challenging because no significant associations were found between lumbar spine magnetic resonance imaging (MRI) findings and LBP [2]
When a diagnosis of discogenic LBP is initially retained, the risk exits of potentially underestimating rare conditions causing chronic LBP
Summary
Low back pain (LBP) is a frequent complaint of up to 80% of middleaged persons at some time during their life [1]. Since combined antiretroviral therapies (cARTs) were introduced, the spinal cord-disease incidence for HIVinfected patients with good immunovirological indices has decreased dramatically [3]. Other than cARTs’ substantial immunological and virological benefits, longstanding HIV-infected patients with prolonged virological suppression may develop lipodystrophy, a rare metabolic complication of antiretrovirals [4]. Spinal epidural lipomatosis (SEL), a rare LBP etiology, should be envisaged for HIV-infected patients, those with HIV-associated lipodystrophy.
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