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Spinal anesthesia in a patient on monoclonal antibody treatment: a poisoned chalice? A case report
Anneleen Herijgers1, Lisa Van Dyck1, Ilse Leroy2
1Anesthesiology, KUL UZ Gasthuisberg, Leuven, Belgium.
Background:
Paraplegia is a rare complication of spinal anesthesia.
Case Presentation:
We report a case of a 68-year-old man who developed postoperative paraplegia and hypoesthesia after spinal anesthesia for an otherwise uncomplicated transurethral resection of the prostate. Acute transverse myelitis was diagnosed based on urgent MRI. A prior history of similar though less severe neurological symptoms after obinutuzumab treatment for follicular lymphoma suggested a potential causative role for obinutuzumab, a novel monoclonal antibody that has not been associated with such devastating neurological side effects yet. High-dose steroid treatment partially attenuated the symptoms, but debilitating hypoesthesia and motor deficit remained present 3 months postoperatively.
Conclusion:
The presented case warrants caution when performing neuraxial anesthesia in patients on monoclonal antibody therapies.
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