Premaxillary Fat Pads on Magnetic Resonance Imaging (MRI) as a Marker of Steroid Side Effects

Premaxillary fat pads visible on magnetic resonance imaging (MRI) are emerging as a sensitive marker for steroid side effects in chronic diseases including pediatric neuroinflammatory disorders where steroids offer proven efficacy in inflammation control and long-term steroids are the mainstay of treatment. However, their use carries significant risks of systemic toxicity, often presenting as abnormal fat redistribution or growth suppression, which can be challenging to identify clinically, especially in children who are overweight or have subtle physical changes. Through this case report, we highlight that routine follow-up MRI in pediatric neuroinflammatory disorders can serve a dual purpose-not only monitoring disease resolution but also acting as a sensitive tool for the early detection of premaxillary fat pad hypertrophy as an indicator of steroid toxicity. Leveraging MRI's superior soft tissue contrast and decreased radiation exposure, such assessments enable objective and timely quantification of steroid-induced changes, facilitating prompt diagnosis and optimal management, particularly in cases where clinical features are subtle or masked.