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(a-d) Spinal MRI at clinical onset. (b) Sagittal T2-weighted image showing the hyperintense lesion extending from C5 to D2 (asterisks); (c) Sagittal T1 post-contrast sequence showing posterior subpial contrast enhancement (asterisks). Axial T1 post-contrast (a) and t2-weighted (d) sequences at symptoms' onset showing the "trident sign" (asterisk). (e and f) spinal MRI 6 months after treatment. Sagittal T2-weighted (e) and T1 post-contrast (f) sequences showing an almost complete disappearance of the spinal lesion.
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Post-contrast scans revealed inhomogeneous enhancement of the lesion, distributed both in the dorsal subpial space and inside the central canal (Figure 1). MRI of the cervical and dorsal spine was performed 6 weeks later showing the almost complete disappearance of the inflammatory lesion and the absence of contrast enhancement (Figure 1). Mycophenolate mofetil was added 3 months later.
Axial chest CT scan showing bilateral hilar adenopathy (asterisks).
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Despite the complete absence of respiratory symptoms, the thoracic CT scan showed multiple enlarged lymph nodes with central colliquation in mediastinal and hilar stations (Figure 2).