Medical Analysis Report

1. Radiological Findings

Based on the provided MRI images of the spine and CT scans of the chest and abdomen, the following key features are observed:

• MRI (Lumbar/Thoracolumbar Sequences): Multiple abnormal signal lesions are visible in the vertebral bodies and paravertebral tissues with relatively distinct boundaries. Local bony signal changes are noted, and some lesions present as lytic or mildly mixed signals. No obvious compressive fractures are identified, but an abnormal signal distribution in the bone marrow suggests possible granulomatous or infiltrative lesions.
• Chest CT: Multiple enlarged lymph nodes are observed in the bilateral hilar and mediastinal regions, with some showing significantly increased diameters. Small nodular shadows are seen in the lung parenchyma, tending to follow bronchovascular bundles or subpleural distribution. Enlarged lymph nodes are also noted in both axillary regions.
• Abdominal CT: Multiple low-density lesions are observed in the liver parenchyma, some with relatively well-defined boundaries. The spleen appears generally uniform in density but may harbor scattered small lesions. Multiple enlarged lymph nodes are present in the abdominal and retroperitoneal areas.
• Skeletal System: Aside from the spine, CT or bone window assessment shows focal areas of decreased bone density with indistinct margins or mild sclerosis, and no obvious fractures. MRI reveals focal or diffuse T1 hypointensity and T2 slightly hyperintense or mixed signals within the bone marrow, with varying degrees of enhancement after contrast administration.

These findings suggest involvement of multiple organs (lymph nodes, bones, liver). Although the radiological presentation resembles metastatic tumors or lymphoma, correlating with clinical and pathological data indicates the possibility of granulomatous diseases (such as Chlamydia trachomatis infection, tuberculosis, sarcoidosis, etc.).

2. Possible Diagnoses

Based on the imaging findings, together with the patient’s clinical history and pathological results, the following differential diagnoses can be considered:

1. Metastatic Tumors (Bone and Liver Metastases): Multiple bone metastases are commonly seen in breast, lung, and prostate cancers. However, no primary lesion has been confirmed in this patient, and there was no improvement after long-term follow-up or anti-tuberculosis treatment, reducing the likelihood of metastatic disease.
2. Lymphoma: It can present with widespread superficial and deep lymphadenopathy and can involve the liver, spleen, and bone marrow. However, pathological examination typically reveals neoplastic cell proliferation, and histology in this case does not support lymphoma.
3. Infectious Diseases (Tuberculosis, etc.): A nine-month course of anti-tuberculosis treatment did not yield significant improvement, and pathology confirmed non-caseating granulomas, essentially ruling out tuberculosis and other common infections.
4. Sarcoidosis (Granulomatous Disease): Characterized by non-caseating granulomas and multi-organ involvement (lymph nodes, bones, liver, eyes, etc.). The patient’s favorable response to corticosteroid therapy further supports this diagnosis.

3. Final Diagnosis

Considering the patient's clinical features (long-standing lymphadenopathy, bone and liver abnormalities, ocular findings), lack of response to anti-tuberculosis therapy, confirmed non-caseating granulomas on pathology, and imaging consistent with sarcoidosis, the most likely diagnosis is "Sarcoidosis (granulomatous lesion)".

If doubts remain, further tests such as pulmonary function evaluation, cardiac MRI to assess cardiac involvement, and additional serologic or molecular studies can be conducted to exclude rare etiologies. However, based on the current data, imaging and pathology strongly support sarcoidosis.

4. Treatment Plan and Rehabilitation

4.1 Treatment Plan

• Pharmacotherapy: Systemic corticosteroids (e.g., oral prednisone) are the first-line treatment. If needed, adjunct immunosuppressants (e.g., methotrexate) can be used to control disease activity.
• Therapeutic Goals: Control the granulomatous inflammation, reduce damage to organ function, and prevent fibrotic progression.
• Follow-up and Monitoring: Perform regular imaging evaluations (chest CT, MRI) and laboratory tests (liver and kidney function, serum calcium levels, etc.) to monitor disease status. Watch for new ocular, cardiac, or neurological symptoms.

4.2 Rehabilitation and Exercise Prescription Recommendations

Because the patient’s skeletal system is involved, it is essential to ensure safety in rehabilitation and exercise, avoiding excessive weight-bearing or high-impact activities. The following plan can be tailored using the FITT-VP principles (Frequency, Intensity, Time, Type, Progression, Individualization):

1. Frequency (F): Engage in low- to moderate-intensity aerobic exercise (e.g., walking, stationary cycling, swimming) three to five times per week.
2. Intensity (I): In the initial phase, maintain a target heart rate of approximately 50%–60% of the maximum heart rate to avoid excessive cardiovascular load. Progress gradually according to tolerance.
3. Time (T): For the first four weeks, each session should last about 20–30 minutes, then gradually increase to 30–45 minutes as tolerated. Take breaks if fatigue, chest tightness, or significant pain develops.
4. Type (T): Prioritize activities with minimal impact on the bones (such as walking in water, walking on flat surfaces, Tai Chi, or gentle yoga). Include moderate core and upper-limb strength training, avoiding heavy weight-bearing movements.
5. Progression (P): As symptoms and fitness improve, adjust the exercise intensity every 4–6 weeks (e.g., increase walking speed or slightly raise device resistance) or add functional exercises (such as balance training).
6. Individualization (I): Adjust the exercise plan and movement range based on the patient’s bone condition, joint flexibility, and cardiopulmonary function. If bone or localized pain occurs, temporarily discontinue related activities and consult a specialist.

Patients with significant bone involvement or active disease phases should pay special attention to avoid stress injuries to the spine or weight-bearing bones.

Disclaimer: This report is based on the provided medical history and imaging data for reference only, and cannot replace in-person consultation or professional medical advice. The final diagnosis and treatment plan must be decided upon after evaluating the patient’s actual clinical condition.