CASE PRESENTATION: 47 year old female with a medical history of valvular cardiomyopathy, chronic kidney disease and hypothyroidism presented with complaints of weakness and falls. She was found to have hypercalcemia and pancytopenia. Parathyroid hormone, Vitamin D, SPEP and UPEP, were within normal limits. C-telopeptide and ACE levels were elevated indicating increased bone turnover and possibility of sarcoidosis. Chest Xray and CT scan were unremarkable for pulmonary involvement or hilar lymphadenopathy. Bronchoscopy with BAL was performed. Bone scan was unremarkable for osseous metastatic disease. Bone marrow biopsy revealed hypercellularity and multiple non-necrotizing epithelioid granulomas. Fungal infection and tuberculosis was ruled out by negative PAS, GMS, mucicarmine and AFB stains. The pancytopenia, elevated ACE level, elevated CD4/CD8 ratio on BAL and non necrotizing granulomas in bone marrow were all supportive of sarcoidosis. Initially 60 mg of prednisone was started which resulted in resolution of pancytopenia, fevers and lethargy. However, when the prednisone was reduced to 40 mg, her symptoms relapsed and 60 mg of prednisone was restarted with no improvement. After discussion, Methotrexate 12.5 mg weekly was initiated with close follow up. Patient has since remained stable. Her pancytopenia has improved, ACE level has normalized and febrile episodes have resolved.