Epidural steroid therapy is a commonly applied "conservative" therapy in the management of acute and chronic back pain, but it is not inherently benign. As the indications for epidural steroid injections increase so do the reports of adverse responses associated with this procedure. Although generalized erythema, retinal hemorrhage, infection, and lipomatosis have been reported, acute generalized ecchymosis has not been reported as a complication of either caudal or spinal epidural steroid injection. We describe here an unique case of transient, profound generalized ecchymosis after receiving an caudal epidural steroid injection for lumbar radiculopathy.