A 35-year-old African-American man presented with cough and mild dyspnea on exertion over 3 to 4 years. His sister was known to have sarcoidosis. Physical examination revealed a slight man with mild clubbing. The chest radiograph (Fig 1
) and chest CT scan (Fig 2
) both demonstrated bilateral diffuse nodular interstitial and alveolar infiltrates, mediastinal and hilar lymphadenopathy, and upper-lobe fibrobullous changes consistent with sarcoidosis. A presumptive diagnosis of sarcoidosis was made; additional evaluation revealed cutaneous anergy, serum angiotensin-converting enzyme level of 108 IU (normal, 8 to 52 IU), chronic uveitis, and marked restriction on pulmonary function testing. No treatment was undertaken at this time.