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A 42-year-old male patient was referred to us in June 1992 for evaluation of low back pain that had been present for 2 months. These pains were concomitant with progressive paresthesias and paresis involving the lower extremities. The physical examination revealed signs of distal sensorimotor polyneuropathy. Cutaneous lesions and supraclavicular adenopathies were noted. There was no deterioration in the general condition. The sedimentation rate was 20 mm/h and usual laboratory values were normal.Plain radiographs (Fig. 1) and computed tomography (CT) of the lumbar spine did not show any abnormalities. The exploration of the lumbar spine by magnetic resonance imaging (MRI; 1.5 T) sagittal scans showed the presence of multiple loci of low signal intensity in Tl-weighted images and high signal intensity in T2-weighted images in the vertebral bodies as well as in the posterior arches of the lumbar and low dorsal spine without abnormalities of the perivertebral soft tissues ( Fig. 2A, B). A fusiform expansion of the low thoracic cord was noted ( Fig. 2A). Signal abnormalities in the sacrum and the iliac crest were observed on the anterior scans. After intravenous administration of Gd-DTPA, the bone lesions became isointense in the bone marrow, and there was leptomeningeal enhancement along the anterior and posterior cord surface and intramedullary enhancement at the T12 level (Fig. 2C). Cerebrospinal fluid examination showed: protein level 0.60 g/1 (normal 0.15~).50g/1); white blood cell count 20 gl; 98% lymphocytes. A vertebral biopsy of L3 was performed.

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