Sarcoidosis presenting with a pleural effusion

A male West Indian patient developed a pleural effusion without radiographic evidence of intra-thoracic lymph node or pulmonary abnormality. A pleural biopsy showed non-caseating granulomas. The Kveim test was positive. During treatment with anti-tuberculosis drugs bilateral pulmonary nodular shadows appeared in the chest x-ray. Anti-tuberculosis chemotherapy was stopped and prednisone given. The nodular shadows resolved.