Spinal Epidural Lipomatosis (SEL) is a rare complication associated with older age, obesity, male sex, systemic corticosteroid use, and epidural corticosteroid injections. Usually incidental (2.5%), SEL can present as a wide spectrum of sequelae from spinal cord compression to chronic lower back pain. While 1.8% of patients are symptomatic, the HIV population presents a unique level of medical complexity given the association of lipodystrophy and combined anti-retroviral therapy (cART).
While some patients improve with conservative management, the association of cART and SEL presents a two-fold problem. Therapy may improve pain but the nidus is still present. Additionally, patients have limited interventional treatments given the association of steroids and SEL. Surgical intervention may improve outcomes but the recurrence of SEL is a possibility given its association with cART.