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A 56 year old female, a case of EPTB – left-sided pleural effusion was evaluated for lack of response to ATT. She underwent pleuroscopy which showed multiple discrete greyish lesions on parietal pleura and biopsy revealed granulomatous lesion. Despite the continuation of ATT for another 2 weeks, the chest tube inserted post pleuroscopy drained 500ml/day. PET CT showed metabolically active med iastinal adenopathy and splenomegaly. She underwent mediastinoscopy and biopsy of the mediastinal node which revealed non-necrotizing granulomas highly suggestive of sarcoidosis. Steroid was initiated and ATT medications were stopped considering sarcoidosis as the diagnosis. Her effusion subsided subsequently and became asymptomatic. She has had no recurrence on follow up so far.