A middle-aged patient with a recent history of a complete surgical resection of a nodular melanoma of the lower back, was referred to the clinic because of increasing exertional dyspnoea. A chest CT showed multiple enlarged mediastinal adenopathies with a micronodular interstitial pattern (figure 1). Transbronchial biopsies revealed non caseating granulomas. Moreover, because ofatrioventricular junctional arrhythmia, an MRI scan of the heart was performed, which showed myocardial granulomas. Sarcoidosis was diagnosed and treated with steroids.

Because of the aggravating cough, a second flexible bronchoscopy was performed four months later this and showed a dark …