Abstract
We present a 63-year-old female, who was referred for an internal medicine consultation due to an orbital mass accompanied by fatigue. After a wide investigation, encompassing the exclusion of infectious and malignant aetiologies, a diagnosis of sarcoidosis was assumed. However, despite this comprehensive evaluation and the initiation of immunosuppressive therapy, we observed a progression of the disease, with an extension of the orbital mass and persistent fatigue, along with multiorgan involvement.
Therefore, this is a sarcoidosis case with an atypical manifestation and progression, rarely reported in literature. We pretend that it serves as a model of the challenges posed by this disease, explaining the various diagnosis hypotheses that we considered and the rationale behind their exclusion.

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