Diagnostic and therapeutic challenges of isolated spinal vasculitis: A case report

The present case report describes a 31-year-old male patient with isolated spinal vasculitis. The patient initially presented with right-hand numbness and weakness, which later extended to both lower limbs, causing gait instability. MRI scans performed after the symptoms had extended to both lower limbs revealed a cervical lesion with T1 hypointensity, T2 hyperintensity and heterogeneous enhancement, initially suspected to be a tumor. Histopathological analysis of the spinal cord biopsy specimen revealed lymphocytic infiltration surrounding the small vessels of spinal cord, supporting a diagnosis of primary isolated spinal vasculitis. The patient was treated with high-dose intravenous methylprednisolone for 9 days (500 mg for 3 days, 250 mg for 3 days and 120 mg for 3 days), resulting in pronounced clinical improvement on follow-up neurological examination and no recurrence at the 2-year follow-up without additional immunosuppressive therapy. The present case underscores the diagnostic challenge of distinguishing vasculitis from spinal tumors and highlights the uncertainty regarding long-term recurrence prevention strategies.