Spinal Cord Sarcoidosis

Spinal cord sarcoidosis is rare, but often appears as a diagnostic challenge in myelopathy of unknown origin. Although definite diagnosis requires histological confirmation of non-caseating epithelioid granuloma in the spinal cord, it is hardly obtained due to the invasiveness of the biopsy procedure. Hence, extensive searches for involvement of other organs involvement should be prompted, including biopsy of the most "promising" and "easy touch" lesions identified in individual patients. Spinal sarcoidosis is generally treated with high-dose corticosteroids, immunosuppressants, or both, but it is often refractory to treatment and requires a long treatment period. Therefore, extensive examinations to evaluate the likelihood of sarcoidosis should be carried out before the initiation of immunotherapy, especially in cases without histological confirmation.