Patients with sarcoidosis are at risk of opportunistic infections both from the sarcoidosis itself and from steroid therapy. Steroid therapy by reducing cell-mediated immunity increases the risk of infection with intracellular organisms. We present a case of Leishmania infection in a 51-year-old Italian woman receiving prednisone for sarcoidosis. The patient lives in Liguria, a region in the northwest of Italy that is considered highly endemic for leishmaniasis. We would postulate that even though leishmaniasis is seen relatively infrequently in connection with sarcoidosis, the occurrence of this opportunistic infection is possible in patients living in areas endemic for such protozoa.