Spinal cord involvement revealing systemic sarcoidosis

Spinal neurosarcoidosis is rare (0.43 p. 100 of all sarcoidosis) and can be the initial manifestation of the disease. A 43-year-old right handed Afric an man developed a progressive dorsal neck pain, slowly worsened paresthesi a weakness in the legs and a gait disturbance. Magnetic resonance imaging ( MRI) scan of the cervical and thoracic spinal cord (sagittal T-1-weighted i mage) revealed diffuse enlargement of the cord from C2 to T7 with intense i ntramedullary enhancement from C2 to T3 after administration of contrast ma terial on sagittal T-1-weighted image. Cranial MRI scan was normal. Radiogr aphs of the chest revealed bilateral symmetric hilar mediastinal lymphadeno pathy with no pulmonary infiltrates. Bronchial biopsy demonstrated non case ating granulomas with langerhans giant cells. The serum angiotensin convert ing enzyme level was elevated. The patient received corticosteroid with goo d progressive response. His neurologic symptoms improved markedly and twent y months post-treatment MRI showed no abnormality on enhanced T-1- weighted images. Two years later he had no relapse.