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Images in Neurology |

Longitudinally Extensive Spinal Cord Lesions Disclosing Occult Systemic Sarcoidosis

Elia Sechi, MD1; Alberto Addis, MD1; Rosanna Piredda, MD1; Anna Laura Rassu, MD1; GianFranco Mameli, MD1; Chiara Senes, MD1; GianPietro Sechi, MD1
[+] Author Affiliations
1Neurological Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
JAMA Neurol. 2016;73(5):600-601. doi:10.1001/jamaneurol.2016.0013.
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This case report describes a man in his 40s who was admitted after 4 months of progressive leg paresthesias and subjective leg weakness.

A man in his 40s was admitted after 4 months of progressive leg paresthesias and subjective leg weakness. The results of a neurological examination were unremarkable. The results of magnetic resonance imaging (MRI) of his brain and laboratory investigations, including testing for aquaporin-4 antibodies, were normal. An examination of his cerebrospinal fluid showed mild hyperproteinorrachia (0.7 g/L), pleocytosis (48 leukocytes/mm3, 95% of which were neutrophils), and 3 oligoclonal bands (mirror pattern). Magnetic resonance imaging of his spine disclosed longitudinally extensive spinal cord lesions with swelling at C2 to C5 and C7 to D3 levels and noncontiguous, patchy gadolinium enhancement along the dorsal columns (Figure 1). The results of radiography of his chest and his serum angiotensin-converting enzyme levels were normal. Computed tomography of his chest revealed hilar lymphadenopathy with increased uptake detected on fluorodeoxyglucose–positron emission tomographic images. A transbronchial biopsy revealed noncaseating granulomas consistent with sarcoidosis (Figure 2). Intravenous methylprednisolone sodium succinate (1 g/d for 5 days) was administered, with resolution of symptoms and nearly complete resolution of MRI-detected lesions. Thereafter, he was treated with azathioprine sodium and prednisone. During the 2-year follow-up period, the patient appeared to be well.

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Figure 1.
Spinal Abnormalities Detected by Use of Magnetic Resonance Imaging (MRI)

A, Sagittal T2-weighted MRI reveals longitudinally hyperintense lesions extending over several vertebral body segments (arrowheads) with swelling at C2 to C5 and C7 to D3 levels. B, Postcontrast T1-weighted images reveal irregular, patchy enhancement along the dorsal columns (arrowheads). C, Near-complete resolution of lesions 12 days after corticosteroid therapy (arrowhead).

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Figure 2.
Lymph Node Histology

Noncaseating nodal granuloma with surrounding histiocytic component (May-Grünwald-Giemsa, original magnification ×200).

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