In rare cases of sarcoidosis, the symptoms and presentation may closely resemble those of metastatic malignant disease affecting the spine. Therefore, it is crucial to include sarcoidosis in our differential diagnosis list.

Sarcoidosis can involve the spine and presents in a picture of multiple lytic lesions. However, it is worth noting that the extent of lytic lesions observed in the presented case is not typically seen in sarcoidosis.

This case report highlights the significance of conducting a comprehensive work-up before proceeding with invasive interventions whenever possible. Providers must consider the patient's neurological condition and the atypical presentation of sarcoidosis.

Attaining a diagnosis should involve various modalities in cases of multiple lytic lesions in the spine before providing treatment to enable precise and adequate management.

Diagnosing the primary pathology can potentially spare the patient from undergoing invasive treatments such as extensive surgeries and radiotherapy.