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A 34-year-old man with multisystem sarcoidosis developed worsening breathlessness, cough, chest pain, palpitations, bone and joint pain, a progressive skin rash and 18 kg weight loss over 2 years. He was diagnosed 3 years earlier with granulomatous uveitis and mediastinal lymphadenopathy, with endobronchial ultrasound-guided biopsy confirming non-necrotising granulomatous inflammation. He was treated with high-dose corticosteroids and methotrexate, and later switched to adalimumab due to steroid toxicity and abnormal liver function. Adalimumab was prescribed at a standard dose of 40 mg every 2 weeks and continued for 2.5 years. Despite this therapy, his disease progressed.