DISCUSSION: Sarcoidosis-like granulomatous disease as a complication of anti-TNF therapy has been rarely described in the literature. Treatment is discontinuation of therapy or oral steroids. Our patient developed sarcoidosis shortly after its cessation. We hypothesize that after the patient’s initial infection, she developed a sarcoidosis flare while off Etanercept, with worsening lymphadenopathy and pulmonary nodules. There was resolution of symptoms and imaging with re-introduction of the medication. Treatment of sarcoidosis with TNF antagonists has yielded mixed results. A phase-2 trial of Etanercept for treatment of stage II and III pulmonary sarcoidosis was stopped early due to treatment failure, yet 5 of 17 patients had treatment success(3).