A Rare Case of Spinal Sarcoidosis Presenting as Multiple Bone Marrow Oedematous Lesions

Sarcoidosis is a systemic disorder that most commonly affects the lungs. Bone involvement is rare, and spinal involvement is even more rare. The presence of focal lesions of the vertebrae is highly suspicious of advanced malignancy. However, malignant metastatic spread to the spine involves the vertebral cortex rather than the bone marrow itself, a distinction that is often missed and therefore misleading. We describe here a middle-aged woman with multiple focal oedematous lesions of the bone marrow suspected of being advanced malignancy but finally diagnosed as a rare case of spinal sarcoidosis. LEARNING POINTS: This article describes a rare case of vertebral sarcoidosis. It emphasizes the often-missed distinction between bone marrow and cortical lesions in the diagnostic work-up of focal spinal lesions. It also underscores the combined use of MRI together with FDG/PET-CT in elucidating the nature of lesions confined to the bone marrow.