[Sarcoidosis revealed by a spinal cord lesion]

Spinal neurosarcoidosis is rarely a presenting symptom. This case deals with a 45-year-old african woman who presented with a regressive spinal cord compression treated by parenteral corticosteroid. Different relapses allowed to diagnose multiple sclerosis. Spinal MRI scan showed diffuse enlargement of the cord with intense intramedullary enhancement from C3 to T1 and an aspect of large spinal cord from C7 to D1. Cranial MRI scan was normal. Radiographs and CT scan of the chest revealed an interstital syndrome without mediastinal lymphadenopathy (subgroup III). The serum angiotensin converting enzyme level was elevated in the blood as the cerebrospinal fluid. CSF fluid showed a lymphocytic meningitis. The bronchio-alveolar lavage found an hyperlymphocytosis with a high CD4/CD8 ratio. The neurological status and biological parameters were improved with oral corticotherapy treatment. This case report that a spinal cord involvement can reveal a sarcoidosis especially in the African race. Finally, in spite of lack of biopsy, the diagnosis is supported by clinical, biological and neuroradiological arguments.