A 50-year-old man with stage 2 sarcoidosis with pleural involvement.

We present a case of a 50-year-old man who presented with progressive shortness of breath, cough, chest pain, and weight loss. His computer tomography (CT) scan of the chest showed a left-sided pleural effusion, subpleural and peribronchovascular nodules, bilateral hilar and mediastinal lymphadenopaties. Traasbronchial biopsies of the lung parenchyma and Video-Assisted Thoracoscopic Surgery (VATS) with pleural biopsies revealed the presence of noncaseating granulomas. A diagnosis of stage 2 sarcoidosis with pleural involvement was made and treatment with prednisone was started. The patient continued with persistent dyspnea and a left-sided pleural effusion. Steroid treatment was tapered and leflunomide therapy was initiated. A significant improvement of his clinical condition was seen after 1 month on treatment.