Pain in the lower limbs of a patient with AIDS.

Diagnosis: Spinal epidural lipomatosis. The patient presente with signs and symptoms suggesting low lumbar nerve root compre sion. MRI showed abundant, generalized fatty tissue and s ecific images of fatty tissue ccumulation in he spinal canal at L5 and the sacrum level, with thecal sac deformity at that s me level (figures 1-4). Spin l epidural lipom osis is a highly uncommon condition in which excess fat accumulates in the epidural space. This accumulation may cause symp oms of myelopathy nd compression of medullary cords or nerve roots. Few cases have be n reported in the literature, a d most of th m are related to an ex genous Cushing syndrome [1] or to severe obesity. The lipodystrophy yndrome associated wi h anti troviral therapy is clinically characterized by a patient's repo t of fat wasting the face, arms, nd/or legs (lipoatrophy), with or ithout fat accumu tion in the abdomen, in th breas s of omen, and ov r he cervical v rtebrae (buff lo hump) [2], that is co firmed by physical examination. A hough pro eas i hibitors were initi lly blamed for this syndrome [3], it is now known tha all therapeutic classes are impl cated, and use of nucleoside anal gu is art cularly related to peri heral l poatrophy [4-5]. We have o ly found 2 repor ed cases of spinal epidural lipomatosis in patients with HIV in ction in th literature. On of the patient had r ceived ritonavir, lamivudine, and zi o udine during h prior 4 months b t also had n exogen us Cushing syndrome caused by long-term corticosteroid th rapy for thro botic thromboc topen c urpu a. This p tient devel ped ep dural l pomatosis