Intense Coughing Following Caudal Epidural Steroid Injection for Lumbar and Lumbo-Sacral Disc Prolapse with Radiculopathy. A Case Report with Pathophysiological Insights

Caudal epidural steroid injection (CESI) is a commonly performed intervention for chronic lumbar and lumbosacral radicular pain, generally considered safe with infrequent adverse effects. We report a rare case of sudden-onset, intense coughing immediately following ultrasound-guided CESI in a 32-year-old male with prolapsed intervertebral disks at the L4-L5 and L5-S1 levels. The episode lasted approximately four minutes and resolved spontaneously without neurological or hemodynamic compromise. Possible mechanisms include cephalad spread of the injectate, inadvertent intravascular injection or dural puncture, systemic drug absorption, allergic reactions to the local anesthetic, steroid, or preservatives, and individual hypersensitivity. This case highlights an unusual, self-limiting complication of CESI and emphasizes the need for vigilant monitoring during interventional pain procedures.