Background: Lung involvement occurs more than 90 percent of sarcoidosis patients, with usual chest x-ray showing bilateral hilar lymphadenopathy and pulmonary infi ltrations. Here we present an unusual sarcoidosis case with multiple pulmonary nodules. Case Presentation: A 32-year old, previously healthy, 15 pack-year current smoker male presented with a 4-month history of masses in both neck and left elbow. He didn`t have any recent history of traveling. The chest X-ray showed bilateral hilar bulging appearance, with nodules in both lung fi elds. Chest computed tomography (CT) revealed multiple lymph node enlargements in both lower neck, mediastinum, axilla and abdomen, along with multiple well-defi ned nodules with variable size range from 0.5 to 3.5cm in both lungs. Both Sputum culture for mycobacteria and interferon gamma releasing assay showed negative. Results: Biopsy of his right neck lymph node was done, which showed chronic granulomatous infi ammation with very focal necrosis. He was initially treated with tuberculosis medications, but showed no improvement. He underwent biopsy once more, forone of lung nodules through percutaneous needle biopsy for pathologic confi rmation, which also showed chronic granulomatous infi ammation without necrosis. Baselineserum angiotensin converting enzyme (ACE) level was 49.5U/L. Thus, he was diagnosed as having sarcoidosis. His lung nodules and masses in neck and elbow have been improved without any treatment. Conclusions: We presented a case with sarcoidosis showing multiple pulmonary nodules, which has been rarely reported before. Sarcoidosis is a multi-organ disorder, and it can have nonspecifi c presentation of symptoms, clinical suspicion and appropriate pathologic confi rm is necessary to make a correct diagnosis.