This case report of progressive bilateral proximal lower extremity weakness along with urine and fecal incontinence in a neurosarcoidosis patient revisits possible side effect of chronic exogenous steroid use causing spinal epidural lipomatosis (SEL) and compressive myelopathy.

35-year-old man with history of neurosarcoidosis as well as systemic sarcoidosis taking prednisone 120 mg daily and azathioprine 50 mg BID was admitted to for two months of progressive bilateral lower extremity weakness along with urine and fecal incontinence. The patient also had moon facies, diabetes mellitus type II and significant weight gain secondary to chronic high dose steroid use. Brain and spine MRI with contrast revealed epidural lipomatosis extending between C7 and T7 at the dorsal aspect of the spinal canal resulting in moderate to severe thecal sac compression on the spinal cord. Prednisone was tapered down over the next 4 weeks to 20mg daily and Azathioprine dose was increased to 100mg BID over the same time period. No acute neurosurgical intervention was done. Patient’s exam improved slightly and eventually was discharged to rehab with neurosurgical follow up with repeat MRI spine in few months.

Comorbidities such as neurosarcoidosis that require long term steroid use are implicated in the pathogenesis of steroid induced SEL. Thoracic spine seems to be commonly affected. Endocrinal conditions secreting steroid hormones, obesity, surgery induced, and idiopathic are also associated.