A pediatric case of acute lymphoblastic leukemia with difficulty in performing lumbar puncture for intrathecal injection due to the development of a spinal epidural lipomatosis

Abstract

Corticosteroid is a vital drug in the management of acute lymphoblastic leukemia (ALL). Repeated lumbar punctures (LPs) are required for intrathecal injections in patients with ALL. Spinal epidural lipomatosis (SEL), an overgrowth of adipose tissue in the extradural space, is a rare complication of intensified corticosteroid treatment for pediatric ALL. Among patients with SEL, difficulty in performing LP is identified as one of clinical manifestiations. We describe the case of a five-year-old boy who immediately developed SEL in the re-remission induction phase. Spinal cord magnetic resonance imaging was performed due to the unsuccessful LP for his thirteenth intrathecal administration. Although no neurological symptoms were observed, he met the diagnostic criteria for SEL. Follow-up imaging performed one month later revealed resolution of the epidural fat deposition, with sufficient space in the spinal cavity, enabling a successful intrathecal injection. This case highlights that SEL should be considered in cases of difficult LP as a possible complication of ALL treatment.