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Spinal sarcoidosis presenting with epiconus syndrome.

A spinal cord lesion is a rare manifestation of neurosarcoidosis. We herein report a case with dysuria and gradually worsening numbness in both lower extremities. Thoracic magnetic resonance imaging (MRI) revealed a long spinal cord lesion with gadolinium enhancement in the lower part of the lesion. Chest computed tomography demonstrated enlarged hilar lymph nodes, and a biopsy revealed sarcoidosis. Methylprednisolone pulse therapy was started, but a follow-up MRI showed aggravation of the spinal lesion. After the addition of methotrexate to the therapy, the patient's aggravation of the spinal lesion and clinical symptoms ceased. Early diagnosis and treatment using combined methylprednisolone and methotrexate therapy may improve this devastating spinal cord disease.