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Revue du rhumatisme
Volume 68, n° 7
pages 648-653 (juillet 2001)
Received : 19 September 2000 ;  accepted : 4 April 2001
Lipomatose épidurale cortico-induite
Glucocorticoid-induced spinal epidural lipomatosis.

Mildreth  Camacho,  Bénédicte  Mugnier * ,  Catherine  Foutrier-Morello,  Hubert  Roux
Service de rhumatologie, hôpital de la Conception, 147, boulevard Baille, 13385 Marseille cedex 05, France 

*Correspondance et tirés à part
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La lipomatose épidurale est une affection rare, définie par l'accumulation de graisse non encapsulée dans l'espace épidural. Nous rapportons l'observation d'une patiente obèse de 74 ans traitée par prednisone (10 à 20 mg/j) depuis trois ans pour pseudopolyarthrite rhizomélique. Il s'installe alors une claudication radiculaire intermittente avec lombalgies. L'imagerie par résonance magnétique met en évidence une lipomatose épidurale s'étendant de L2 à S1. La lipomatose épidurale est une complication probablement sous-estimée de la corticothérapie prolongée. Un diagnostic précoce permet d'appliquer un traitement conservateur et d'éviter une chirurgie lourde.

Mots clés  : corticothérapie ; iatrogénie ; lipomatose épidurale ; obésité.

Abstract

Spinal epidural lipomatosis is an uncommon condition in which unencapsulated fat accumulates within the epidural space. We report a case in a 74-year-old obese patient who had been taking prednisone (10 to 20 mg per day) for 3 years to treat pseudomyalgia rheumatica. Intermittent radicular claudication and low back pain were the presenting symptoms. Magnetic resonance imaging showed epidural lipomatosis extending from L2 to S1. Spinal epidural lipomatosis is probably an underdiagnosed complication of long-term glucocorticoid therapy. Cases diagnosed early can be managed conservatively, whereas later on major surgery is unavoidable.

Mots clés  : glucocorticoid therapy ; iatrogenic complications ; obesity ; spinal epidural lipomatosis.




© 2001  Éditions scientifiques et médicales Elsevier SAS. All Rights Reserved.

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