Article Figures & Data
Figures
- Figure 1
(A) T2-weighted magnetic resonance image (MRI) of the cervical spine with sagittal cut showing body involvement at C2, C3, and C4 with the anterior soft tissue component at C2 and C3. (B) T2-weighted MRI of the cervical spine with axial cut at the C4 level showing significant epidural soft tissue component and epidural spinal cord compression grade 3 at the C4 level.
- Figure 2
(A) Whole spine computed tomography (CT) image with sagittal cut showed the lytic lesions in C2, C3, C4, and T6. (B) CT image with axial cut at the C4 level showed the lytic lesion involvement of the posterior cortex of C4.
- Figure 3
(A) Axial positron emission tomography-computed tomography (PET-CT) and axial CT images demonstrated multiple hypermetabolic pulmonary nodules and ground glass opacities involving both lung fields (blue arrowheads). (B) Axial PET-CT and axial CT images demonstrated a large hypermetabolic abdominal mass lesion occupying the right paramedian region (blue curved arrow) along with evidence of 2 subcutaneous nodules involving the left lateral abdominal wall and left inner thigh (blue asterisk). (C) Axial PET-CT images and coronal PET-CT images demonstrated multiple hypermetabolic lytic bone lesions involving the sternum, right 1st, 7th, and 8th ribs, as well as T6, L3 vertebrae, and the most prominent C4 vertebral body lesion (white arrows). (D) Maximum intensity projection image demonstrated a hypermetabolic process involving bilateral pulmonary nodules (blue arrowheads), abdominal mass lesion (blue curved arrow), 2 skin nodules (blue asterisk), and multiple lytic bone lesions (black arrows). The overall picture was potentially suspicious, necessitating tissue confirmation by biopsy to exclude malignant pathology.
- Figure 4
(A) Histopathologic finding of noncaseating granuloma. (B) Negative staining by Ziel-Neelsen. (C) Negative staining by Grocott’s Methenamine Silver stain.
- Figure 5
(A) T2-weighted magnetic resonance image (MRI) of the cervical spine with sagittal cut showed significant improvement in the soft tissue components at C2, C3, and C4. (B) T1-weighted MRI of the cervical spine with axial cut at the C4 level showed near resolution of the significant epidural soft tissue component and epidural spinal cord compression at the C4 level.
- Figure 6
Three months after treatment. (A) T2-weighted magnetic resonance image (MRI) of the cervical spine with sagittal cut. (B) T2-weighted MRI of the cervical spine with axial cut at the C4 level revealed interval sclerosis and decreasing enhancement of the lesions at C2, C3, C4, T1, and T6.
- Figure 7
Eight months after treatment. (A) Spine computed tomograpghy (CT) image with axial cut showed partial calcification of the lytic lesion in C4. (B) CT image with sagittal cut showed partial calcifications in the other lesions.
- Figure 8
Eight months after treatment, lateral (A) and anteroposterior (B) cervical spine x-ray images showed normal findings.
Tables
Key findings 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.
What is known and what is new? 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.
What is the implication, and what should change now? 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.
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