A 48-year-old female presented to us with a history of symmetric, tingling paresthesia in the lower limbs for the past 9 months, which progressively ascended to involve the trunk and neck. On examination, she had loss of joint position and vibration sensations over the lower limbs and trunk, a sensory level at the mid-thoracic region, spasticity of bilateral lower limbs, and a positive Romberg's sign. MRI spine and brain showed longitudinally extensive T2 and fluid-attenuated inversion recovery hyperintensities, involving the posterior column with contrast enhancement [Figure 1]. MRI brain was normal. Causes of longitudinally extensive tract specific spinal cord lesions including neuromyelitis optica spectrum disorders (NMOSDs), paraneoplastic myelopathies, and Vitamin B12 deficiency were initially considered. Laboratory tests revealed normal levels of serum Vitamin B12 levels (1085 pg/ml; normal range 211-911 pg/ml) and serum copper (115 mug/dl; normal range 85-155 mug/dl) whereas serum aquaporin 4 antibody was negative. Screening for blood biomarkers for cancer including cancer antigen (CA)-125, Carcino Embryonic Antigen, CA 19-9, and alpha-feto protein were negative. Cerebrospinal fluid examination revealed five cells (all lymphocytes), mildly elevated proteins (57 mg/dl; normal 15-45 mg/dl), and normal sugar (66 mg/dl; normal 45-80 mg/dl). Computerized tomography (CT) of the thorax showed paratracheal, hilar, and subcarinal nodes in addition to the right upper lobe fibrosis. Serum angiotensin-converting enzyme levels were normal (50 U/L; normal range 8-53 U/L). CT-guided transthoracic biopsy of the mediastinal lymph nodes was then performed and histopathologic evaluation revealed noncaseating granulomas. Staining and polymerase chain reaction for mycobacterium tuberculosis was negative. A diagnosis of systemic sarcoidosis with neurological involvement was made, and the patient was started on intravenous followed by oral steroids. She noted significant improvement in clinical symptoms with treatment.