CASE PRESENTATION: A 44 year old African American woman with a past medical history of diabetes, obesity, and asthma presented with shortness of breath for one month. She had been treated with Prednisone for a presumed asthma exacerbation; her breathing improved initially but deteriorated after being tapered off Prednisone. She ultimately came to our facility as her respiratory status worsened and she developed night sweats and unintentional weight loss. Chest radiograph revealed a mass-like opacity in the left lower lobe. CT Chest revealed a left lower lobe mass and diffuse hilar lymphadenopathy, which was concerning for malignancy. Initial CT-guided biopsy of the lung mass revealed granulomatous disease consistent with Sarcoidosis and without evidence of malignancy, fungal infection, or infection with acid fast bacilli. However, given the atypical presentation and ongoing concern for malignancy, bronchoscopy and then mediastinoscopy were performed. These both confirmed the diagnosis of Sarcoidosis. Prednisone was initiated but management has been challenging due to frequent episodes of hyperglycemia requiring insulin therapy. Given her robust response, Prednisone has been continued despite poor glucose control. Repeat imaging after 3 months shows a significant decrease in the size of the left lower lobe lung mass.