Case of a 35‐Year‐Old Man With Pain With Sneezing and Leg Weakness Causing Collapse

This case details a 35-year-old man with no past medical history who presents with acute paraparesis and urinary retention in the setting of progressive paresthesias and weakness of his lower and upper extremities over several months. He was found to have longitudinally extensive transverse myelitis involving the cervical to mid-thoracic cord with concomitant findings of mediastinal and hilar lymphadenopathy. An extensive serum and cerebrospinal fluid (CSF) workup of possible autoimmune, paraneoplastic, infectious, and toxic/metabolic etiologies was overall nonrevealing, but an endobronchial ultrasound-guided biopsy of the enlarged hilar lymph nodes revealed noncaseating granulomas. The patient demonstrated significant improvement after completing two courses of pulse-dose steroids and was ultimately discharged to intensive inpatient rehabilitation for further treatment.