Sarcoidosis, case 2

Clinical history
44-year-old male patient presents with complains of progressive spastic paraparesis for two years, with progression over the last six months. Presently, the patient is unable to walk without help. No urinary disturbances are noted although there has been erectile dysfunction for six months.

MR examination
Image 1: Sagittal T2WI. High signal intensity of the Th4 vertebral body is linked to the presence of a vertebral hemangioma. Moreover, at this level, a spinal cord lesion is demonstrated as a high intensity signal lesion (arrow).
Image 2: Sagittal T1WI. The vertebral hemangioma appears equally hyperintense on this image. The intramedullary lesion is slightly hyperintense.
Image 3: After contrast injection, the intramedullary lesion enhances intensely.

Conclusion
We observe the presence of a small and homogeneously enhancing nodular lesion without major cord enlargement. Demyelinating disease was included in the differential diagnosis. Still, thoracic CT revealed enlargement of the anterior mediastinal lymph nodes. As sarcoidosis was clinically suspected, a biopsy of the salivary glands was performed. The diagnosis of granulomatous sialadenatis, compatible with the diagnosis of sarcoidosis was made. For those reasons, the patient was put on Cortisone-therapy. Only minor clinical improvement was observed. After a few months, the patient could again walk without support but severe spasticity was still present.

One follow-up MRI (not shown here) performed six months later, disclosed disappearance of the signal abnormalities within the spinal cord.

Final diagnosis
Spinal cord sarcoidosis

Search also:
- Sarcoidosis

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