Sarcoidosis is a notoriously protean disease, but vertebral involvement is a rare entity. This is a case report of biopsy-proven thoracic and lumbar vertebral sarcoidosis in a 48-year-old Hispanic female with low back pain. Although this patient had normal plain films and computed tomography of the spine, her disease was first visualized by magnetic resonance imaging. The imaging findings were nonspecific, and the initial impression was hematopoietic malignancy vs disseminated infection.