[A case of spinal sarcoidosis complaining of chest and back pain as a first manifestation and mimicking syringomyelia on MRI].
The patient was a 24-year-old female complaining of bell-shaped chest and back pain with visual disturbance. Chest X-ray showed bilateral hilar lymphadenopathy without the presence of pleural effusion. Bronchoalveolar fluid showed lymphocytosis with an elevated CD 4/CD 8 ratio. Transbronchial lung biopsy demonstrated a non-caserous granulomatous lesion with an accumulation of epitheloid cells, suggesting lung sarcoidosis. No abnormality of electrocardiogram was detectable, and spinal tap for examination of chest and back pain demonstrated on elevated level of beta 2-microglobulin, and a normal angiotensin converting enzyme level. Spinal MRI showed a lineal lesion mimicking syringomyelia on T 2-weighted image. Steroid administration was started for the chest and back pain, since the spinal lesion was suspected due to spinal sarcoidosis. All clinical and laboratory findings, without the presence of pleural effusion or cardiac fluid, supported the diagnosis of spinal sarcoidosis causing chest and back pain. In the literature, patients with spinal sarcoidosis manifesting chest and back pain and with a MRI finding mimicking syringomyelia have been rarely reported. This case might be important in considering spinal cord sarcoidosis as a differential diagnosis of chest and back pain.
Misawa
Masafumi
M
First Department of Internal Medicine, Tokyo Medical University, 6-7-1 Nishi-Shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Utsumi
Kenta
K
Nagate
Akira
A
Kunisawa
Akira
A
Kasuga
Ikuma
I
Minemura
Kazushige
K
Ohyashiki
Kazuma
K
D000328:Adult; D001416:Back Pain / Q000209:etiology*; D002637:Chest Pain / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D012507:Sarcoidosis / Q000175:diagnosis*; D013118:Spinal Cord Diseases / Q000175:diagnosis*; D013595:Syringomyelia / Q000175:diagnosis*