This is a case of neurosarcoidosis affecting the spinal cord. While the classic trident sign was not identified in this case, there was long-segment myelitis (the longitudinally extensive transverse myelitis pattern).

The patient underwent C6 to T1 laminectomy and autograft bone placement for resection of the lesion. Histopathology revealed epithelioid histiocytes and multinucleated giant cells. There was gliotic spinal cord tissue (highlighted on GFAP and NF) and lymphocytic reaction of small benign-appearing lymphocytes (predominantly CD3-positive T cells with a minor population of CD20-positive B cells). AFB and GMS stains were negative for mycobacteria and fungi. The Ki-67 labeling was low (2-3%). There was no evidence of necrotizing vasculitis, neoplasia, or inflammatory demyelination. Given these findings, this non-necrotizing granulomatous inflammation was favored to represent sarcoidosis.