Worsening Epidural Lipomatosis Leading to Foot Drop Following an Epidural Steroid Injection: A Case Report

Epidural lipomatosis is a relatively rare condition resulting in the accumulation of unencapsulated fatty tissue within the epidural space. Steroids, either exogenous or endogenous, have been reported as a cause for this accumulation. The diagnosis is confirmed by computed tomography or magnetic resonance imaging. Symptomatic epidural lipomatosis has been reported to present with radiculopathy, myelopathy, claudication, cauda equina syndrome, or paraplegia. It is usually managed conservatively, including weight loss and avoidance of steroids.

We report the case of a patient with sarcoidosis on oral prednisone who was referred for low back and leg pain of multifactorial origin. After addressing his low back pain, a fluoroscopically guided lumbar epidural steroid injection was performed for his neurogenic claudication. This provided 3 months of complete pain relief. But the patient also developed unilateral foot drop, possibly secondary to worsening epidural lipomatosis.

Epidural lipomatosis may result in complications that include neurological deficits. Although various disease states may cause it, prudence is advised in the use of exogenous steroids.