When common diagnoses fail: The complexity of sarcoidosis in the elderly: Case report

Sarcoidosis is a rare but complex multisystem granulomatous disease that can mimic common respiratory conditions, leading to delayed diagnosis. We present a 75-year-old female with type 2 diabetes and hypertension who experienced persistent cough, fatigue, and occasional unconsciousness for months. Initial workups, including chest X-rays and tuberculosis screening, were inconclusive, and empirical treatments for pneumonia failed to provide relief. Her condition progressed to significant weight loss, night sweats, and lymphadenopathy. High-resolution computed tomography (HRCT) later revealed mediastinal lymphadenopathy, bilateral infiltrates, and pulmonary nodules, strongly suggesting sarcoidosis. Due to biopsy refusal, histological confirmation was unavailable, yet her dramatic response to corticosteroids and methotrexate solidified the diagnosis. This case highlights the importance of early suspicion, serial imaging, and clinical response in diagnosing sarcoidosis, especially in elderly patients, where histopathological confirmation may not be feasible.