Pulmonary Sarcoidosis Associated With Pleural Effusion: A Case Report.

Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology that predominantly affects the lungs and intrathoracic lymph nodes. Pleural involvement is uncommon, and sarcoidosis-associated pleural effusion (SAPE) represents a rare clinical manifestation, reported in approximately 1% of cases. We describe a 24-year-old male presenting with bilateral pleural effusion and mediastinal lymphadenopathy. Comprehensive diagnostic evaluation revealed a lymphocyte-predominant exudative pleural effusion with negative microbiological and cytological findings. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) demonstrated non-caseating granulomas consistent with sarcoidosis. Elevated serum angiotensin-converting enzyme (ACE), soluble interleukin-2 receptor (sIL-2R), and serum amyloid A (SAA) supported active disease. The patient achieved complete clinical, biochemical and radiological remission following systemic corticosteroid therapy. This case highlights the importance of a rigorous differential diagnostic approach and careful clinicoradiological-histopathological correlation in rare presentations of sarcoidosis.