Spinal epidural lipomatosis associated with HIV and antiretroviral therapy: a case report of conservative resolution with optimization of antiretroviral therapy (ART)

Abstract

Spinal epidural lipomatosis (SEL) is a rare condition characterized by excessive accumulation of adipose tissue in the extradural space, which can compress neural structures and lead to neurological deficits. Although classically associated with corticosteroid use and obesity, SEL has also been observed in patients with Human Immunodeficiency Virus (HIV), particularly in relation to highly active antiretroviral therapy (HAART) and associated lipodystrophy. This case report describes a 38-year-old HIV-positive male patient who had interrupted antiretroviral therapy (ART) for six years and subsequently developed progressive paraparesis, hypoesthesia, and loss of sphincter control. Magnetic resonance imaging of the thoracic spine revealed posterior epidural lipomatosis with spinal canal stenosis. After reinitiating ART, the patient showed significant improvement in neurological deficits, with recovery of motor strength and sphincter control, correlated with optimization of virological and immunological parameters (viral load and CD4 count). This case highlights the importance of considering SEL in the differential diagnosis of myelopathy in HIV-infected patients receiving ART and suggests that, in selected cases, optimization of ART may lead to conservative resolution of spinal cord compression, avoiding the need for surgical intervention.