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Case report
Spinal anesthesia in a patient on monoclonal antibody treatment: a poisoned chalice? A case report
  1. Anneleen Herijgers1,
  2. Lisa Van Dyck1,
  3. Ilse Leroy2,
  4. Laurens Dobbels3 and
  5. Peter B C Van de Putte2
  1. 1 Anesthesiology, KUL UZ Gasthuisberg, Leuven, Belgium
  2. 2 Anesthesiology, Imeldaziekenhuis, Bonheiden, Belgium
  3. 3 Neurology, Imeldaziekenhuis, Bonheiden, Belgium
  1. Correspondence to Dr Peter B C Van de Putte, Anesthesiology, Imeldaziekenhuis, Bonheiden 2820, Belgium; doktervdputte{at}gmail.com

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.

  • injections
  • spinal
  • drug-related side effects and adverse reactions
  • neurotoxicity syndromes
  • postoperative complications

https://doi.org/10.1136/rapm-2021-102557

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    Footnotes

    • Contributors AH: This author contributed to the conception and authorship of the article. LVD: This author contributed to the conception and authorship of the article. IL: This author contributed to the clinical care and authorship of the article. LD: This author contributed to the clinical care and authorship of the article. PBCVdP: This author contributed to the conception and authorship of the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.