A 44-year-old man presented with 2 weeks of progressive right body numbness, weakness, and circumferential burning sensation around his trunk. MRI spine demonstrated longitudinally extensive myelitis (figure 1). MRI brain and laboratory investigations were normal except for CSF lymphocytic pleocytosis (9 leukocytes/mm3). CT revealed hilar and mediastinal lymphadenopathy, which on biopsy showed noncaseating granulomas suggestive of sarcoidosis. As the patient had multiple clinical relapses on steroids, he was treated with infliximab infusions (5 mg/kg every 4 weeks) and had complete clinical and radiologic resolution after 1 year (figure 2). Myelitis as the presenting feature of sarcoidosis is exceptionally rare and responds to infliximab.1,2
- © 2013 American Academy of Neurology
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