Recurrent massive pleural effusion with neurosarcoidosis: a rare presentation of sarcoidosis.

49 year old female, a known case of thalassemia minor with hypothyroidism on treatment, presented with left sided massive pleural effusion. Pleural tapping revealed exudative effusion and she was started on four drug AKT. She had recurrent pleural effusions and required repeated aspirations. Thoracoscopic pleural biopsy revealed non caseating granulomas. She continued to deteriorate after 8 months of AKT and was readmitted with severe vomiting, ataxia, diplopia, weakness and weight loss. Investigations revealed miliary pattern on CXR and multiple granulomatous lesions in the brain on MRI. She responded to treatment with high dose corticosteroids. We are presenting this case to highlight sarcoidosis as one of the causes of large pleural effusion.