A 60-year-old woman complained of chest and axillary pain, which had initially appeared three months previously and had recently become worse. A chest CT revealed hilus-mediastinal lymphadenopathy. Because an increased serum ACE level was observed, sarcoidosis was suspected and further investigations performed. The number of lymphocytes had also increased in the BALF (67%) and the CD4/CD8 ratio was significantly higher than normal (7.5). A histological examination of a specimen obtained by TBLB revealed epithelioid cell granuloma. FDG-PET CT showed an increased uptake in the hilus-mediastinal lymph node and thoracic spinal cord. An abnormal image suggesting extradural epithelioid cell granuloma was identified at the C7-Th8 levels of the thoracic spinal cord by MRI. The pain was thus suspected to have been caused by compression of the spinal cord due to the presence of the epithelioid cell granuloma. Oral administration of prednisolone (50mg/day) improved her symptoms as well as the findings on both FDG-PET CT and MRI.
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