SARCOIDOSIS PRESENTING AS CERVICAL CORD SYNDROME. D. Bradley 1 , E. Lower 1 , R. Baughman 1 , L. Coberly 1 ; 1 University of Cincinnati, Cincinnati, OH (Tracking ID #73947) LEARNING OBJECTIVES: To recognize that sarcoidosis is a rare but treatable cause of spinal cord lesions that can mimic malignant tumors of the spine clinically and radiologically. CASE INFORMATION: A 53 year-old African American male presented with a six month history of worsening neck pain, progressive upper and lower extremity weakness, and difficulties with bowel and bladder function. He also noted severe fatigue and a 30 pound weight loss over the last eight months. Physical examination was remarkable for flaccid paralysis of his right upper extremity, 3/5 strength of his left upper extremity, and 3/5 strength of his lower extremities. He had decreased rectal tone. Significant laboratory findings included a normal CBC, chemistry panel, and liver function studies. Calcium was elevated at 11.5 mg/dL (nl 8.4±10.2), an ACE level was normal. Cerebral spinal fluid studies were unremarkable. MRI of the spine showed extensive abnormal signal involving the entire cervical cord extending through T3 with diffuse, patchy nodular enhancement and edema from C3±C7 suspicious for malignancy. CT of the chest revealed mediastinal adenopathy. Biopsy of subcarinal lymph nodes showed noncaseating granulomas consistent with sarcoidosis. The patient was treated with high dose corticosteroids and IV cyclophosphamide (off label use as a steroid sparing agent) with marked improvement. Repeat MRI six months later was normal. IMPLICATIONS/DISCUSSION: The spinal cord is involved in less than 1% of patients with sarcoidosis. It is rarely the first manifestation of disease. Sarcoidosis of the spinal cord can be can be clinically and radiologically indistinguishable from a malignant tumor of the spine. Definitive diagnosis requires pathologic examination of the spinal cord lesions or, as in our patient, other associated lesions such as hilar adenopathy. Prompt treatment with high dose corticosteroids is essential to a favorable outcome. Steroids may need to be continued indefinately. There has been some success using steroid-sparing agents such as cyclophosphamide to decrease the dose and duration of steroid therapy. Sarcoidosis is a treatable condition that should be included in the differential diagnosis of spinal cord lesions.