A 50-year-old woman presented with progressive spastic quadriparesis. MRI of the spine showed a longitudinally extensive T2 hyperintensity throughout the cervical spine. The lesion demonstrated central canal and dorsal-subpial enhancement forming a “trident,” a pattern previously described in spinal cord sarcoidosis (Figure).1 Fluorodeoxyglucose-PET revealed increased uptake in the cervical cord but no alternative systemic biopsy site. The patient’s quadriparesis worsened while receiving several courses of corticosteroids and an infliximab trial for presumed sarcoidosis. Spinal cord biopsy revealed diffuse large B-cell lymphoma.