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A woman in her mid-40s presented with progressive shortness of breath, high-protein ascites, omental thickening and hypercalcaemia. Initially suspected to have disseminated tuberculosis (TB), the patient did not respond to the antitubercular therapy. Further evaluation revealed non-caseating granulomas on omental biopsy and elevated serum Angiotensin- Converting Enzyme (ACE) levels, confirming the diagnosis of sarcoidosis. This case highlights a diagnostic dilemma between sarcoidosis and TB, particularly in regions with high disease prevalence. This underscores the importance of integrating the clinical, radiological and histopathological findings for accurate diagnosis and management.