We present a case of a 57-year-old African American man with systemic sarcoidosis, who initially presented with cervical spinal cord disease. Initial MRI showed an elongated intramedullary area of increased signal intensity on T2 and inversion recovery sequences within the cervical spinal cord with minimal contrast enhancement after gadolinium administration. Further radiologic evaluation led to a chest CT, which showed bilateral hilar lymphadenopathy. Thoracic lymph node biopsy revealed systemic sarcoidosis. Post treatment MRI showed improvement of the cervical spinal cord lesion, further supporting the diagnosis of systemic sarcoidosis.