In 2010, a 53-year-old female patient was consulted to the gastroenterology clinic with complaints of fatigue and abdominal pain. Biochemical analysis revealed elevated blood levels of alanine aminotransferase (41 U/L), aspartate aminotransferase (108 U/L), alkaline phosphatase (ALP; 649 U/L), gamma-glutamyltransferase (GGT; 361 U/L) and a negative autoimmune panel. Ultrasound examination revealed hepatomegaly, and thoracic computed tomography results indicated that the lymph nodes in the mediastinum, paratracheal, and precarinal regions were 2x1 cm in size. Tru-Cut biopsy (Becton Dickenson and Co., Franklin Lakes, NJ, USA) of the liver was performed with the initial diagnoses of tuberculosis, lymphoma, and sarcoidosis. The histopathological evaluation indicated noncaseating granulomatous inflammation in the parenchyma consistent with grade 3 macrovesicular steatosis and foci of intralobular non-necrotising granulomatous inflammation (Figs. 1-3). Ziehl-Neelsen staining results were unremarkable. As the angiotensin-converting enzyme level was 5 times higher than the upper limit of normal (250 U/L; normal: 8-52 U/L), the case was evaluated as sarcoidosis with hepatic involvement, and the patient was sent to a center with a sarcoidosis polyclinic. Treatment and follow-up continue.