An 87-year-old female presented with progressive paraparesis (i.e., left leg 3/5 and right leg 2/5) of 5 days’ duration. The patient was started on Rocephin for a urinary tract infection, but computed tomography angiogram of the head and neck and magnetic resonance imaging of the thoracic spine showed extensive bony metastatic disease with an epidural tumor at T4–T7 with severe cord compression []. She underwent a T3– T8 laminectomy for tumor resection. Preoperatively, she was given intravenous immunoglobulin, platelet transfusion, fresh frozen plasma, and Vitamin K to normalize her international normalized ratio (INR). The pathology revealed a myeloid sarcoma with monocytic differentiation and CD68-positive immunohistochemical staining [ and ]. Postoperatively, she regained some strength in her lower extremities. However, once a bone marrow biopsy revealed diffuse involvement with myeloid sarcoma and monocytic differentiation, she elected no further treatment (i.e., chemotherapy or radiation) and expired 4 months later.