Wolf in Sheep's Clothing: A Case of Sarcoidosis Exacerbating Asthma

As a leading cause of chronic respiratory morbidity worldwide, asthma remains a complex disorder characterized by inflammation, recurrent exacerbations, and episodic symptoms. Pulmonary sarcoidosis is a potential misdiagnosis for asthma. Symptoms such as shortness of breath, chest tightness, and dry cough can be present in both conditions, making differentiation difficult. This case highlights the diagnostic challenges and clinical overlap between severe asthma and sarcoidosis in a patient with uncontrolled respiratory symptoms, underscoring the importance of considering other etiologies when standard asthma management is ineffective in controlling symptoms. We present the case of a 59-year-old man with a history of severe asthma who continued to have persistent and worsening respiratory symptoms despite high-dose inhaled steroids, long-acting beta agonists (LABAs), long-acting antimuscarinics, and biologic therapy. Pulmonary function testing evolved from reversible obstruction to a more restrictive pattern, prompting imaging of his chest and subsequent lung biopsy, revealing noncaseating granulomas. This case highlights the diagnostic challenges and clinical overlap between severe asthma and sarcoidosis in a patient with uncontrolled and exacerbating respiratory symptoms.