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Epidural Spinal Lipomatosis With Acute Onset of Paraplegia in an HIV-Positive Patient Treated With Corticosteroids and Protease Inhibitor: Case Report

Study Design. Case report. Objective. To report a case of HIV-related lipodystrophy with a rapid onset of symptoms from epidural lipomatosis in the wake of protease inhibitor and steroid treatment. Summary of Background Data. Symptomatic spinal epidural lipomatosis is considered to be a rare condition usually presenting with slowly progressive cord or nerve root compression. Only 2 cases of spinal lipomatosis in HIV-related lipodystrophy have been reported. Methods. We describe the case of a 41-year-old male with HIV who received protease inhibitor medication and had neurologic deficits rapidly develop. Results. The patient had complete paraplegia develop within 12 hours from admission following a 1-day history of unsteady gait and a 3-day history of leg numbness. After diagnosis of epidural lipomatosis on magnetic resonance imaging, the patient underwent decompressive thoraco-laminectomy. He recovered well and was able to walk by postoperative day 4. Conclusion. It is important to maintain an awareness for the possible association between HIV lipodystrophy and symptomatic epidural lipomatosis.