Introduction Sarcoidosis is a multisystem disease characterized histologically by noncaseating granulomas. Localization of sarcoidosis to the CNS is termed neurosarcoidosis, a complex and rare neuroinflammatory form of sarcoidosis. When the spinal cord is involved, lesions are often intradural. Here, we present a rare case of progressive myelopathy secondary to multifocal spinal extradural neurosarcoidosis with spinal cord compression and without pulmonary involvement. Case presentation A 29-year-old African American female presented to the emergency department with numbness and paresthesia of 2-month duration in her left lower extremity and 2-week duration in her right lower extremity. The patient reported difficulty ambulating, paresthesia below the umbilicus, and back pain radiating to bilateral lower extremities. She endorsed 9-month history of cough, subjective fevers, night sweats, and unintentional 15 kg weight loss. Examination revealed 4/5 strength in the left lower extremity. MRI of the brain and spinal cord revealed enhancing extradural lesions, with spinal cord compression at T8 measuring 1.3 × 1.9 cm. Lumbar puncture demonstrated oligoclonal bands and increased CSF neutrophils, lymphocytes, monocytes, and protein. T8 laminectomy with resection of the epidural lesion was performed. Histology showed granulomas, consistent with neurosarcoidosis. At follow-up, repeat spinal MRI revealed disease progression with intramedullary involvement. Long-term immunosuppressive treatment was eventually initiated with satisfactory response. Discussion This is a rare case of myelopathy secondary to spinal extradural neurosarcoidosis. Spinal neurosarcoidosis is predominantly an intradural process. Our review of the literature identified only seven cases of extradural neurosarcoidosis presenting with compressive myelopathy. Additional insight into management and rehabilitation following pathological diagnosis is of clinical significance.

We systematically reviewed published data on autopsies of patients who died from COVID-19 to identify pathological changes that are consistently reported in autopsies and those that were reported anecdotally, and to compare consistent findings with autopsy findings in similar diseases. The MEDLINE, Google Scholar, and Embase databases were searched for full-text articles in the English language from December 2019 to March 2021 to include publications on autopsy findings in patients whose main cause of death was COVID-19 and COVID-19-related complications. This review included 124 published papers documenting COVID-19 patient autopsies for over 1100 patients. Most frequent and consistently reported pathological findings included diffuse alveolar damage in the lungs, cardiac inflammation, and hypertrophy, vascular microthrombi, shock kidney and acute tubular necrosis, congested liver and spleen, and shock-associated changes in other organs. These findings by themselves were not unique, and were similar to other severe viral infections and septic shock. However, the frequency of diffuse alveolar damage and the extent of microvascular thrombosis were much higher among the autopsies of patients who had died from COVID-19 compared with other severe viral infections. Autopsy data confirm clinical reports of high incidences of diffuse alveolar damage and microvascular thrombosis in the most severe cases of COVID-19 that caused death.

Background: Comprehensive spine centers (CSCs) offer multidisciplinary care, with input from various specialists, including spine surgeons, physiatrists, pain physicians, chiropractors, and therapists to improve care in patients with spinal pathology. Methods: A 62-year-old female with history significant for remote cervical spine fusion and chronic low-back pain due to left sacroiliac joint dysfunction and lumbosacral spondylosis status post recent L3-L5 laminectomy and fusion, presented to a CSC for evaluation of increased right-sided nociceptive back pain after hearing an audible "snap." Results: Examination was notable for tenderness to palpation over the lumbosacral paraspinals and the right sacroiliac joint, reproduction of mild axial low back pain with extension and left flexion abduction external rotation (FABER) test. Advanced imaging revealed no pseudoarthrosis involving the instrumented lumbar spine levels, though incidentally noted multiple prominent and borderline enlarged lymph nodes in the right supraclavicular and superior paratracheal regions. Computed tomography (CT) scan of the neck and chest re-demonstrated indeterminate lymphadenopathy. Excisional lymph node biopsy revealed early-stage follicular lymphoma (FL). Conclusion: This case highlights the ability of comprehensive spine centers to make surprising diagnoses through comprehensive assessments of patients with complex spinal abnormalities as part of a multidisciplinary model of care.

Structured Background: Herpes zoster is an uncommon clinical entity in the pediatric population, with incidence increasing with age. The syndrome is characterized by neuralgia and vesicular rash due to reactivation of latent varicella zoster virus within the dorsal root ganglion. Case presentation: A 15-year-old immunocompromised male with history including orthotopic heart transplant and developmental disability presented with subacute right lower extremity pain and refusal to ambulate. The patient had initially been diagnosed and treated for muscle strain and urinary tract infection during a recent emergency department visit. Differential diagnoses included osteomyelitis, myositis, occult fracture, venous thrombus, or intra-abdominal pathology. Laboratory workup revealed elevated inflammatory markers (ESR 16, CRP 1.4). Femur/pelvis magnetic resonance imaging identified proximal right rectus femoris edema. CT abdomen/pelvis incidentally noted disc bulge and retrolisthesis of L5 on S1. Physiatry was consulted for suspected lumbar radiculopathy/radiculitis. He denied low back pain or radiation. Examination revealed an uncomfortable but nontoxic patient. Right lower extremity skin inspection identified a vesiculopapular rash in the L4 dermatomal distribution. Lower extremity strength and sensation was intact, with notable right medial thigh allodynia, guarding and pain-limited right lower-extremity active range of motion. Straight-leg raise testing was negative. Physiatry recommended shingles workup in the setting of immunosuppression. Varicella zoster virus polymerase chain reaction of vesicular fluid returned positive. Conclusions: This patient’s chronic anti-graft rejection immunosuppression and recent urinary tract infection had likely elicited viral reactivation and the clinical manifestation of herpes zoster. The patient’s neuralgia and viral exanthema within the distribution of the affected dermatome resolved gradually after standard treatment with intravenous acyclovir and initiation of gabapentin. This case emphasizes the importance of a broad differential diagnosis in pediatric patients presenting with acute pain, including consideration of herpes zoster, and underscores the importance of thorough physical examination with careful skin inspection, including full exposure of the affected extremity to avoid diagnostic anchoring.