Lady with low back ache

A 57 yr female presented with LOW BACK ACHE of 3 weeks duration .

There was no history of trauma . She had no neuro deficit.

She was able to perform activities of daily life ,However the pain intensity

increased

MRI spine was done as shown in Fig 1 and Fig2
MRI showed altered marrow signal of L2 vertebral body with involvement of

Rt psoas and erector spine muscles. FNAC revealed non caseating granuloma with high ACE levels
After few days  she presented to  our hospital with  sudden onset of breathlessness with rml and RLL collapse and consolidation with large pleural effusion
HRCT showed   bronchocele with narrowing of bronchi
and pleural  fluid analysis shows exudative fluid with neutrophils.

FNAC was repeated and patient was managed as Lymphoma

Teaching message :Lymphoma may present with high ACE levels like Sarcoidosis