Giorelli Maurizio, Altomare Sergio, Leone Ruggiero, Balzano Rosario F, Orlando Silvio, Di Fazio Pasquale, Santo Leonardo
Operative Unit of Neurology, "Dimiccoli" General Hospital, Barletta, ITA.
Operative Unit of Radiology, "Dimiccoli" General Hospital, Barletta, ITA.
Cureus. 2025 Feb 18;17(2):e79227. doi: 10.7759/cureus.79227. eCollection 2025 Feb.
The diagnosis of sarcoidosis-related longitudinally extensive transverse myelitis (LETM) is challenging, requiring the exclusion of mimicking conditions along with histopathological confirmation of the diseases affecting the spinal cord. This report presents the case of a 68-year-old woman with complaints of low back pain and tingling dysesthesia in the limbs one month prior and finally developed paraparesis with the need for support from a third person for walking. Magnetic resonance imaging (MRI) of both the brain and spinal cord, total body computed tomography, lumbar puncture, flow cytometry of the cell sediment from cerebrospinal fluid (CSF), and whole-body 18-F-fluorodeoxyglucose positron emitting tomography (FDG-PET) assisted us to finalise the diagnosis. The presence of the "trident sign" in axial sequences of MRI is of exceptional value since it is a clue for sarcoidosis of the spinal cord. CSF flow cytometry may help clinicians to rule out lymphoma, and FDG-PET can help clinicians in identifying manifestations of sarcoidosis, which need to be biopsied so as to unveil the final diagnosis.
结节病相关的长节段横贯性脊髓炎（LETM）的诊断具有挑战性，需要排除模仿病症，并对影响脊髓的疾病进行组织病理学确认。本报告介绍了一名68岁女性的病例，该患者一个月前出现腰痛和肢体刺痛性感觉异常，最终发展为双下肢轻瘫，行走需要第三人扶持。脑部和脊髓的磁共振成像（MRI）、全身计算机断层扫描、腰椎穿刺、脑脊液（CSF）细胞沉淀物的流式细胞术以及全身18-F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）辅助我们完成了诊断。MRI轴位序列中“三叉戟征”的存在具有特殊价值，因为它是脊髓结节病的一个线索。脑脊液流式细胞术可帮助临床医生排除淋巴瘤，FDG-PET可帮助临床医生识别结节病的表现，这些表现需要进行活检以揭示最终诊断。
