A 74 year-old Caucasian male presented with unintentional weight loss and fatigue. Physical examination revealed conjunctival pallor and massive splenomegaly. Labs were notable for pancytopenia and hypercalcemia. CT chest/abdomen/pelvis revealed mediastinal lymphadenopathy and massive splenomegaly. Further laboratory workup showed elevated vitamin D levels and normal ACE levels.

Bone marrow biopsy revealed multiple non- nectrotizing granulomas with slight hypercellular bone marrow showing otherwise normal trilienage hematopoiesis.

A diagnosis of sarcoidosis was made on the basis  of clinical presentation, mediastinal lymphadenopathy, hypercalcemia and presence of non necrotizing granulomas on bone marrow biopsy.