Spinal anesthesia in a patient on monoclonal antibody treatment: a poisoned chalice? A case report. Issue 9 (19th April 2021)

• Record Type: Journal Article
• Authors: Herijgers, Anneleen; Van Dyck, Lisa; Leroy, Ilse; Dobbels, Laurens; Van de Putte, Peter B C
• Is Part Of: Regional anesthesia and pain medicine. Volume 46:Issue 9(2021)
• Page Start: 828
• Page End: 830
• Publication Date: 2021-04-19
• Subjects: injections -- spinal -- drug-related side effects and adverse reactions -- neurotoxicity syndromes -- postoperative complications; Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1136/rapm-2021-102557
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Background: Paraplegia is a rare complication of spinal anesthesia. Case presentation: We report a case of a 68-year-old man who developed postoperative paraplegia and hypoesthesia after spinal anesthesia for an otherwise uncomplicated transurethral resection of the prostate. Acute transverse myelitis was diagnosed based on urgent MRI. A prior history of similar though less severe neurological symptoms after obinutuzumab treatment for follicular lymphoma suggested a potential causative role for obinutuzumab, a novel monoclonal antibody that has not been associated with such devastating neurological side effects yet. High-dose steroid treatment partially attenuated the symptoms, but debilitating hypoesthesia and motor deficit remained present 3 months postoperatively. Conclusion: The presented case warrants caution when performing neuraxial anesthesia in patients on monoclonal antibody therapies.