An 82-year-old Japanese man complained of a 1-month history of otherwise asymptomatic papules and nodules distributing on the abdomen, shoulders, and extremities. Some of the abdominal skin lesions corresponded with the sites of subcutaneous insulin injection therapy for uncontrollable type 2 diabetes mellitus. Of note, the skin nodules clustering on the forearms tended to overlie exclusively the median basilica, cubital, or cephalic veins (Fig. 1a, b). These lesions showed fluctuation during his clinical course, irrespective of the skin sites of periodic blood sampling and insulin injection, and further extended along the peripheral venous lines of his forearm skin (Fig. 1c, d). Transcutaneous ultrasonography of the forearm lesions revealed demarcated, homogeneous, hypoechoic areas surrounding superficial veins, suggestive of peri-/intravascular granuloma (Fig. 1e, f). Laboratory tests showed elevated levels of ESR (39 mm/h), CRP (1.07 mg/dL), sIL-2R (1,803 U/mL), and HbA1c (7.3%), without increase in serum calcium and ACE levels. The QuantiFERON-TB and tuberculin skin tests were negative. Owing to the refusal to obtain the skin biopsy from his forearm lesions, the skin sampling was undertaken from the abdominal lesion. The histopathology showed a nonnecrotic, noncaseating epithelioid granuloma with a relatively lower infiltration of inflammatory cells in the lower dermis and adipose tissue (Fig. 2). Bilateral hilar lymphadenopathy (BHL) and a solitary mass in the left gluteus minimus muscle were detected on positron emission tomography screening (Fig. 3a, b, respectively). Ophthalmological and cardiovascular examinations did not show any granulomatous lesions. Based on these findings, we made a diagnosis of sarcoidosis involving the skin, skeletal muscle, and BHL. During 1 year of follow-up, his abdominal skin lesion almost diminished with topical steroid therapy (Fig. 4a), but the forearm skin lesions often recurred along the venous lines (Fig. 4b, c). His blood test revealed improvement of the sIL-2R level (677 U/mL) but BHL remained unchanged.