Division of Rheumatology and Immunology, Children's Hospital, Medical Faculty "Carl Gustav Carus", Technical University Dresden, Fetscherstr, 74, 01307 Dresden, Germany.
Pediatr Rheumatol Online J. 2011 Feb 1;9(1):5. doi: 10.1186/1546-0096-9-5.
Spinal epidural lipomatosis is a rare complication of chronic corticosteroid treatment. We report a new pediatric case and an analysis of this and 19 pediatric cases identified in the international literature. The youngest of these combined 20 patients was 5 years old when lipomatosis was diagnosed. Lipomatosis manifested after a mean of 1.3 (+/- 1.5) years (SD) (median, 0.8 years; range, 3 weeks - 6.5 years) of corticosteroid treatment. The corticosteroid dose at the time of presentation of the lipomatosis ranged widely, between 5 and 80 mg of prednisone/day. Back pain was the most common presenting symptom. Imaging revealed that lipomatosis almost always involved the thoracic spine, extending into the lumbosacral region in a subset of patients. Predominantly lumbosacral involvement was documented in only two cases. Although a neurological deficit at presentation was documented in about half of the cases, surgical decompression was not performed in the cases reported after 1996. Instead, reducing the corticosteroid dose (sometimes combined with dietary restriction to mobilize fat) sufficed to induce remission. In summary, pediatric spinal epidural lipomatosis remains a potentially serious untoward effect of corticosteroid treatment, which, if recognized in a timely manner, can have a good outcome with conservative treatment.
脊柱硬膜外脂肪增多症是慢性皮质类固醇治疗的罕见并发症。我们报告了一例新的儿科病例，并对该病例和国际文献中确定的 19 例儿科病例进行了分析。这些 20 例患者中年龄最小的为 5 岁，诊断为脂肪增多症。脂肪增多症在皮质类固醇治疗 1.3(+/-1.5)年后（SD）（中位数为 0.8 年；范围为 3 周-6.5 年）出现。脂肪增多症出现时的皮质类固醇剂量差异很大，在 5 至 80mg 泼尼松/天之间。背痛是最常见的首发症状。影像学显示，脂肪增多症几乎总是累及胸椎，在一部分患者中延伸至腰骶部。仅有两例记录到单纯腰骶部受累。尽管约一半的病例在就诊时出现神经功能缺损，但自 1996 年后报告的病例中并未进行手术减压。相反，减少皮质类固醇剂量（有时结合饮食限制以动员脂肪）足以诱导缓解。总之，儿童脊柱硬膜外脂肪增多症仍然是皮质类固醇治疗的一种潜在严重不良反应，如果及时发现，采用保守治疗可获得良好的结果。
