Think out of the box! Pediatric onset adult Sarcoidosis in a young child presenting as Pyrexia of unknown origin

Sarcoidosis is a rare multi-systemic granulomatous disease that can have myriad of presentations in childhood. A five-year old female child presented with recurrent fever from two years of age and hepato-splenomegaly. She had no arthritis, rash or uveitis. She had been extensively investigated and yet, remained undiagnosed for a period of three years. Finally, a liver and lymph node biopsy yielded the diagnosis of sarcoidosis. In children presenting with pyrexia of unknown origin (PUO), when a thorough history, physical examination and initial investigations fail to provide direction, tissue biopsy must be considered. To the best of our knowledge, this is the first report of pediatric-onset adult sarcoidosis presenting at such a young age, from the Indian subcontinent. It aptly high-lights the need to consider sarcoidosis as a possibility in children presenting with PUO.